Daswani Ravi, Kumar Ashish, Anikhindi Shrihari Anil, Sharma Praveen, Singla Vikas, Bansal Naresh, Arora Anil
Sir Ganga Ram Hospital, Institute of Liver, Gastroenterology, and Panceatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education and Research, Rajinder Nagar, New Delhi, 110 060, India.
Indian J Gastroenterol. 2018 Mar;37(2):141-152. doi: 10.1007/s12664-018-0842-0. Epub 2018 Apr 28.
Severe alcoholic hepatitis (AH) is not an uncommon indication for hospital admission in India. However, there is limited data from India on predictors of mortality in patients of severe AH. We analyzed the data on patients with severe AH admitted to our institute and compared various parameters and severity scores in predicting 90-day mortality.
In this prospective study, we analyzed patients with severe AH (defined as discriminant function ≥ 32) admitted from January 2015 to February 2017 to our institute. All patients were administered standard treatment according to various guidelines, and their 90-day mortality was determined. Various hematologic, biochemical factors, and severity scores were compared between survivors and patients who died.
A total of 183 patients (98% males, median age 41 years [range 20-70 years]) were included in our study. The median model for end-stage liver disease (MELD) was 26 (15-40). Ascites were present in 83% and hepatic encephalopathy in 38%. Only 21 (12%) could be offered steroid therapy, due to contraindications in the remaining. By 90 days, only 103 (56%) patients survived while 80 (44%) died. All patients died due to progressive liver failure and its complications. On multivariate analysis, presence of ascites, hepatic encephalopathy, high bilirubin, low albumin, high creatinine, high INR, and low potassium independently predicted 90-day mortality. All the scores performed significantly in predicting 90-day mortality with no statistically significant difference between them. MELD score had a maximum area under the curve 0.76 for 90-day mortality. A combination of Child class and presence of acute kidney injury (creatinine ≥ 1.35) was good in predicting 90-day mortality.
Our patients had severe AH characterized by a median MELD score of 26 and had a 90-day mortality of 44%. Most patients were not eligible to receive corticosteroids. Presence of Child C status and high serum creatinine value (≥ 1.35 mg/dL) accurately predicted mortality. Newer treatment options need to be explored for these patients.
在印度，重症酒精性肝炎（AH）是住院治疗的常见病因之一。然而，印度关于重症AH患者死亡率预测因素的数据有限。我们分析了我院收治的重症AH患者的数据，并比较了各种参数和严重程度评分对90天死亡率的预测情况。
在这项前瞻性研究中，我们分析了2015年1月至2017年2月期间我院收治的重症AH患者（判别函数≥32）。所有患者均按照各种指南接受标准治疗，并确定其90天死亡率。比较了幸存者和死亡患者的各种血液学、生化因素及严重程度评分。
我们的研究共纳入183例患者（98%为男性，中位年龄41岁[范围20 - 70岁]）。终末期肝病模型（MELD）中位数为26（15 - 40）。83%的患者有腹水，38%的患者有肝性脑病。由于其余患者存在禁忌证，仅有21例（12%）患者接受了类固醇治疗。到90天时，仅有103例（56%）患者存活，80例（44%）患者死亡。所有患者均死于进行性肝功能衰竭及其并发症。多因素分析显示，腹水、肝性脑病、高胆红素、低白蛋白、高肌酐、高国际标准化比值（INR）和低钾独立预测90天死亡率。所有评分在预测90天死亡率方面均有显著表现，且相互间无统计学显著差异。MELD评分对90天死亡率的曲线下面积最大，为0.76。Child分级与急性肾损伤（肌酐≥1.35）的组合对90天死亡率的预测效果良好。
我们的患者患有重症AH，MELD评分中位数为26，90天死亡率为44%。大多数患者无资格接受皮质类固醇治疗。Child C级状态和高血清肌酐值（≥1.35mg/dL）可准确预测死亡率。需要为这些患者探索新的治疗选择。
