Prognostic models for alcoholic hepatitis

Rahimi, Erik; Pan, Jen Jung

doi:10.1186/s40364-015-0046-z

Cited by 25 publications

(28 citation statements)

References 53 publications

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“…Louvet et al, had observed marked decrease in 6 months survival in the patients having Lille score ≥ 0.45. Mortality was 25 ± 3.8 % in the subgroup of patients having Lille score < 0.45 versus 85 ± 2.5% in the subgroup with Lille score ≥ 0.45 (P value < 0.0001) 14 . We found that there were 68.4% death in subgroup of patients with Lille score ≥ 0.45 whereas there were no death at all in the subgroup with Lille score < 0.45.…”

Section: Fig 2: Percentage Of Deaths In the Two Subgroups Of Lille Smentioning

confidence: 86%

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Untitled

2018

IJPSR

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Background: Alcoholic liver disease is a spectrum of alcohol induced injury that includes fatty liver, alcoholic hepatitis and alcoholic cirrhosis. Corticosteroids are used in cases of severe alcoholic hepatitis with Maddrey's Discriminant Function score > 32. However, many of the patients who are being managed by corticosteroids are non responders and mortality increases in such patients. Lille model is a prognostic model which helps in identification of steroid responders and non responders within 7 days of start of treatment. In the present study we identified the alcoholic hepatitis patients with Lille score < 0.45 and with > 0.45. Survival in the patients was compared with the Lille score. Method: Prospective study of 100 patients of alcoholic hepatitis aged 18 to 85 years was done for a period of six months. All of the patients were managed with similar treatment protocols including general supportive measures and treatment of associated complications. Oral or Intravenous corticosteroid therapy was given for 28 days and then tapered off over next two weeks in the subgroup of patients with Lille score < 0.45. Patients were followed up till the end of 6 months. Result: Lille score was significantly (p < 0.005) lower in survival group (mean 0.35 ± 0.17) compared to non survival group (mean 0.72 ± 0.15). Using Receiver Operating curve, we found that cut off points for Lille Score in our population is 0.47. These patients are not benefitted from steroid therapy and should be considered for alternative therapy like liver transplant. Conclusion: brief summary and potential implications: Lille score is a valuable marker for identifying the patients who could be benefitted by corticosteroids. This study indicates a need for developing a new cut off point for Lille Score.

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Section: Fig 2: Percentage Of Deaths In the Two Subgroups Of Lille Smentioning

confidence: 86%

“…It is highly predictive of death at six months in patients with alcoholic hepatitis 14 . Lille score may be as accurate at day 4 as at day 7 in predicting response to corticosteroids as well as 90 day mortality 15 .…”

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confidence: 96%

Untitled

2018

IJPSR

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“…Available scoring systems for assessing the severity and prognosis of AH are Modified MDF based on PT and serum bilirubin concentration; GAHS that uses variables including age, blood urea, peripheral blood leukocyte count, serum bilirubin, and PT; the MELD score using bilirubin, creatinine, and INR levels; the Lille model which combines six variables (age, renal insufficiency, albumin, PT, bilirubin, and evolution of bilirubin on day 7). Scoring systems include differing cut-offs, various clinical and laboratory parameters; combining more than one scoring system, as well as establishing new scoring models, could improve the current practice [8]. CH is symptomatic, biochemical, or serological evidence of continuing or relapsing hepatic disease for more than six months.…”

Section: Discussionmentioning

confidence: 99%

“…The NAFLD Activity Score is used for the assessment of any degree of the NAFLD and is under critical evaluation in many recent studies [7]. Maddrey Discriminant Function (MDF) and Glasgow Alcoholic Hepatitis Score (GAHS) are used for defining severity and predicting mortality in patients with alcoholic hepatitis (AH) [8]. International Autoimmune Hepatitis Group developed a scoring system for diagnostic, differential diagnostic, and prognostic purposes in patients with autoimmune hepatitis (AIH).…”

Section: Introductionmentioning

confidence: 99%

Performance of a calculator for diagnosing the cause of liver damage

et al. 2019

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Introduction/Objective Making a calculator that would recognize patterns of abnormal liver function tests and link them to the most probable etiology could help clinicians in their initial orientation towards a definitive diagnosis in patients with liver damage. The aim of our study was to design, construct, and validate a calculator that based on a pattern of abnormalities in liver function tests of a patient with liver damage would propose the most probable etiology. Methods Patterns of abnormal liver function tests for certain etiology of liver damage were extracted from distributions of actual values taken from reports in medical literature about patients whose etiology of liver damage was proven by reliable diagnostic tests. After setting up the calculator with the patterns extracted, its diagnostic value was checked under real-life conditions, on a sample of patients with liver damage whose etiology was established by the gold standard of diagnostics (biopsy or else). The calculator validation study was carried out at the Military Medical Academy in Belgrade during a two-year period (2015)(2016). Results For all tested diagnoses, the calculator demonstrated a highly significant difference between the area under the receiver-operator curves' values and the value of 0.5 (p < 0.001), and high level of sensitivity (more than 90%, except for the model for chronic hepatitis) as well as relatively high specificity (more than 75%) were noted, indicating good ability of the calculator to detect etiology of liver damage. Conclusion New calculators showed satisfactory sensitivity and specificity for revealing major liver damage etiologies.

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“…The MELD score performs relatively well but its sensitivity and specificity varies depending upon the threshold taken to identify severe disease. This varies between 18 and 25 with no consensus between guidelines or reviews . It should also be noted that the MELD, mDF, ABIC and GAHS are all subject to significant inter‐laboratory variation.…”

Section: Prognostic Scoresmentioning

confidence: 99%