Suzuki Yuji, Kakisaka Keisuke, Suzuki Akiko, Takahara Takeshi, Sasaki Tokio, Sato Takuro, Yonezawa Takehiro, Nitta Hiroyuki, Takikawa Yasuhiro
Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
Hepatol Res. 2019 Jul;49(7):758-764. doi: 10.1111/hepr.13334. Epub 2019 Apr 29.
Corticosteroids are the most widely used agents for the treatment of severe alcoholic hepatitis (SAH). The therapeutic effectiveness of corticosteroids is assessed by the Lille model, which has been validated well in patient cohorts in North America and Europe; however, its usefulness has not yet been confirmed independently in Japanese patients. The present study aimed to determine whether the Lille model could predict the prognosis of SAH in Japanese patients.
This was a retrospective cohort study including 32 SAH patients who were admitted to our institute from April 2011 to February 2018. According to the previously validated Lille model cut-off value, patients who received corticosteroids were classified as corticosteroid responders or non-responders (with responders obtaining a Lille score ≥ 0.45), followed by assessment for the 6-month prognosis.
Out of 32 patients, 26 were treated with corticosteroids. The 28-day and 6-month mortality rates in the corticosteroid-treated group were 23.1% and 46.2%, respectively. The median Lille score was significantly higher in patients who died or underwent liver transplantation (0.647) than in those who survived without undergoing transplantation (0.226; P < 0.0182). The 6-month transplant-free survival rate of non-responders (Lille score ≥ 0.45) was significantly lower (27.3%; 95% confidence interval, 9.0-58.6%) than that of responders (Lille score < 0.45, 73.3%; 95% confidence interval, 46.7-90.0%; P = 0.0149, log-rank test).
The Lille score could be useful for predicting the 6-month prognosis of Japanese SAH patients after corticosteroid therapy.
皮质类固醇是治疗重症酒精性肝炎（SAH）最广泛使用的药物。皮质类固醇的治疗效果通过里尔模型进行评估，该模型在北美和欧洲的患者队列中已得到充分验证；然而，其在日本患者中的有效性尚未得到独立证实。本研究旨在确定里尔模型是否能够预测日本SAH患者的预后。
这是一项回顾性队列研究，纳入了2011年4月至2018年2月期间入住我院的32例SAH患者。根据先前验证的里尔模型临界值，接受皮质类固醇治疗的患者被分为皮质类固醇反应者或无反应者（反应者的里尔评分≥0.45），随后评估6个月的预后。
32例患者中，26例接受了皮质类固醇治疗。皮质类固醇治疗组的28天和6个月死亡率分别为23.1%和46.2%。死亡或接受肝移植的患者的中位里尔评分（0.647）显著高于未接受移植而存活的患者（0.226；P<0.0182）。无反应者（里尔评分≥0.45）的6个月无移植生存率显著低于反应者（里尔评分<0.45，73.3%；95%置信区间，46.7-90.0%；P=0.0149，对数秩检验）。
里尔评分可用于预测日本SAH患者接受皮质类固醇治疗后的6个月预后。
