Analysis of individual data from five RCTs showed that corticosteroids significantly improve 28-day survival in patients with severe alcoholic hepatitis. The survival benefit is mainly observed in patients classified as responders by the Lille model.

Introduction: Alcoholic hepatitis is associated with a high short term mortality. We aimed to identify those factors associated with mortality and define a simple score which would predict outcome in our population. Methods: We identified 241 patients with alcoholic hepatitis. Clinical and laboratory data were recorded on the day of admission (day 1) and on days 6-9. Stepwise logistic regression was used to identify variables related to outcome at 28 days and 84 days after admission. These variables were included in the Glasgow alcoholic hepatitis score (GAHS) and its ability to predict outcome assessed. The GAHS was validated in a separate dataset of 195 patients. Results: The GAHS was derived from five variables independently associated with outcome: age (p = 0.001) and, from day 1 results, serum bilirubin (p,0.001), blood urea (p = 0.019) and, from day 6-9 results, serum bilirubin (p,0.001), prothrombin time (p = 0.002), and peripheral blood white blood cell count (p = 0.001). The GAHS on day 1 had an overall accuracy of 81% when predicting 28 day outcome. In contrast, the modified discriminant function had an overall accuracy of 49%. Similar results were found using information at 6-9 days and when predicting 84 day outcome. The accuracy of the GAHS was confirmed by the validation study of 195 patients The GAHS was equally accurate irrespective of the use of the international normalised ratio or prothrombin time ratio, or if the diagnosis of alcoholic hepatitis was biopsy proven or on the basis of clinical assessment. Conclusions: Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. This score was able to identify patients at greatest risk of death throughout their admission.

Objective: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints. Design: Systematic review.

on behalf of the British Society for Rheumatology Standards, Guidelines and Audit Working Group Scope and purpose Background to the disease The clinical presentation of a hot swollen joint is common and has a wide differential diagnosis. The most serious is septic arthritis, which accounts for significant morbidity, and has a case fatality of 11% [1]. Delayed or inadequate treatment leads to irreversible joint damage [2]. Rapid diagnosis and treatment is vital to prevent permanent joint dysfunction. This guideline will focus on the diagnosis and management of septic arthritis. Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis and a monoarticular presentation of polyarthritis. The need for a guideline The hot swollen joint presents to many different clinicians in primary or secondary care. Poor outcomes including permanent joint destruction and death can occur if the diagnosis of sepsis is not made rapidly and treatment instigated appropriately. Septic arthritis can be difficult to recognize even for experienced clinicians, yet such patients frequently present to doctors unfamiliar with the assessment and management of joint disease. We hope that this guideline will aid accurate diagnosis and appropriate treatment when a joint is hot because of sepsis, whilst also ensuring that other causes such as crystal arthritis are recognized and not over-treated. Objectives of the guideline This guideline sets out recommendations for the diagnosis and initial management of septic arthritis presenting clinically as a hot swollen joint. These recommendations are based on a systematic review of the literature and evaluation of the evidence using standardized criteria.

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