Foncea Camelia Gianina, Sporea Ioan, Lupușoru Raluca, Moga Tudor Voicu, Bende Felix, Șirli Roxana, Popescu Alina
Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania.
Center of Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
J Clin Med. 2021 May 27;10(11):2338. doi: 10.3390/jcm10112338.
Lille score at Day 7 (LM7) helps to predict the outcome of patients with severe alcoholic hepatitis (sAH) undergoing corticotherapy. Several scores such as Maddrey's discriminant function (MDF), MELD, ABIC, and GAHS are used for a 28-day mortality prognosis. Our study aimed to evaluate if the assessment of the Lille score at 4 days (LM4) is as useful as the Lille score at Day 7 (LM7) to predict response to corticosteroids and 28-day mortality and evaluate the utility of severity scores at admission for predicting the prognosis of patients with liver cirrhosis (LC) and severe alcoholic hepatitis (sAH). A retrospective study was performed, and all consecutive patients with AH and MDF > 32 without contraindications to corticosteroids were included. Prognostic scores were evaluated at admission, and 28-day mortality was assessed. Response to corticotherapy was assessed by LM4 and LM7. Results: A total of 55/103 patients with sAH (51.5%) had MDF > 32 and received corticosteroids. There was no difference between the proportion of patients with a responder LM4 versus LM7 (27% vs. 36%, = 0.31). The mean value for LM4 was 0.64 ± 0.3 versus 0.60 ± 0.3 for LM7 ( = 0.48). Precisely 90.3% of patients were correctly identified as responders or not by LM4 compared with LM7. The best model for predicting 28-day mortality was composed of MELD and LM4/LM7, with an accuracy of 0.90 for both combinations. Conclusion: LM4 could be used instead of LM7 for predicting response to corticosteroid therapy in patients with sAH and LC, as well as 28-day mortality. Using LM4, we could avoid prolonged use of this therapy and its complications.
第7天的里尔评分（LM7）有助于预测接受皮质激素治疗的重症酒精性肝炎（sAH）患者的预后。诸如马德雷判别函数（MDF）、终末期肝病模型（MELD）、ABIC和GAHS等多种评分用于28天死亡率的预后评估。我们的研究旨在评估第4天的里尔评分（LM4）在预测对皮质类固醇的反应和28天死亡率方面是否与第7天的里尔评分（LM7）一样有用，并评估入院时严重程度评分在预测肝硬化（LC）和重症酒精性肝炎（sAH）患者预后方面的效用。进行了一项回顾性研究，纳入了所有连续的AH患者且MDF>32且无皮质类固醇使用禁忌证。入院时评估预后评分，并评估28天死亡率。通过LM4和LM7评估对皮质激素治疗的反应。结果：103例sAH患者中有55例（51.5%）MDF>32并接受了皮质类固醇治疗。LM4反应者与LM7反应者的患者比例无差异（27%对36%，P=0.31）。LM4的平均值为0.64±0.3，而LM7为0.60±0.3（P=0.48）。与LM7相比，精确地有90.3%的患者被LM4正确识别为反应者或非反应者。预测28天死亡率的最佳模型由MELD和LM4/LM7组成，两种组合的准确率均为0.90。结论：LM4可用于替代LM7来预测sAH和LC患者对皮质类固醇治疗的反应以及28天死亡率。使用LM4，我们可以避免这种治疗的长期使用及其并发症。
