The Glasgow alcoholic hepatitis score identifies patients who may benefit from corticosteroids

Abstract

Introduction: There is no consensus on the pharmacological treatment of alcoholic hepatitis. The Glasgow alcoholic hepatitis score (GAHS) has been shown to be more accurate than the modified Maddrey's discriminant function (mDF) in the prediction of outcome from alcoholic hepatitis. This study aimed to determine whether the GAHS was able to identify those patients who would benefit from corticosteroids. Methods: 225 patients with an mDF greater than or equal to 32 from five hospital centres in the United Kingdom were reviewed. Patient survival relative to the GAHS and the use of corticosteroids was recorded. Results: 144 patients with an mDF greater than or equal to 32 (64%) also had a GAHS greater than or equal to 9. There was no difference in survival between untreated or corticosteroid-treated patients for those with a GAHS less than 9. For patients with a GAHS greater than or equal to 9 the 28-day survival for untreated and corticosteroid-treated patients was 52% and 78% (p = 0.002), and 84-day survival was 38% and 59% (p = 0.02), respectively. Conclusions: Among patients with an mDF greater than or equal to 32, there was no appreciable benefit from treatment with corticosteroids in patients with a GAHS less than 9. Patients with a GAHS greater than or equal to 9 have an extremely poor prognosis if they are not treated with corticosteroids, or if such treatment is contraindicated.

Homozygosity for rs738409:G in PNPLA3 is associated with increased mortality following an episode of severe alcoholic hepatitis

“…Routinely collected demographic and laboratory data were used to calculate prognostic scores viz: The Model for End-Stage Liver Disease (MELD), [37]; the Glasgow Alcoholic Hepatitis Score (GAHS), [38] and the Lille score [39]. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Patients self-categorised their current drinking behaviour at day 90 as (i) abstinent; (ii) drinking at low levels: men 24g/day; women: 16 g/day; (iii) drinking at moderate levels: men >24 but 60g/day; women >16 but 40 g/day; (iv) drinking at high levels: men >60g/day; women >40g/day.…”

“Pseudotumoral” hepatic pattern in acute alcoholic hepatitis: A case report

“…Our case scored a total of 63, 14 and 9, respectively, compared to reference values of 32, 21 and 9. A mDF ≥ 32 and a GAHS score ≥ 9 identify patients with a very poor prognosis who have been reported to have had a good clinical response to corticosteroids [23] . Based on an mDF of 63 and a GAHS of 9, a corticosteroid regimen was instituted and then slowly progressive tapered down, on the basis of progressive clinical, laboratory and radiological improvement.…”

Alcoholic hepatitis: Diagnosis and prognosis

“…The GAHS score uses age, white blood cell count, urea level, PT ratio or INR, and bilirubin level to calculate a score between 5 and 12, with scores above 9 associated with poor prognosis. 12 The initial study showed an accuracy of 81%, with values on day 1 in predicting day 28 mortality. In a follow-up study, patients with scores of 9 or greater had significant reduction of mortality if they received corticosteroids.…”

“…In a follow-up study, patients with scores of 9 or greater had significant reduction of mortality if they received corticosteroids. 12 The Lille model is used to predict the mortality in patients with severe AH who have received glucocorticoids for treatment. This model includes six variables (age, renal insufficiency [INR >1.3 or creatinine clearance <40], albumin, PT, bilirubin level, and bilirubin level on day 7) that are used to determine mortality at 6 months.…”