Division of Gastroenterology, Hepatology, Nutrition at Virginia Commonwealth University (VCU) Health, Richmond, VA, USA.
, 2505 Durhamshire Place, Midlothian, VA, 23113, USA.
Dig Dis Sci. 2024 Aug;69(8):3043-3050. doi: 10.1007/s10620-024-08479-6. Epub 2024 Jun 18.
BACKGROUND/AIMS: In alcohol-associated hepatitis (AH), the Lille score is used to assess futility of steroids. However, the ability of the Lille score to predict 30-day survival in AH is not well-defined. Our aim is to compare the utility of the Lille score in predicting 30-day survival in those with AH treated with steroids.
Retrospective chart review of 882 patients hospitalized with AH from January 1st, 2012 through December 30th, 2019 was performed. Of these, 201 patients with severe AH met the threshold to receive steroids. Those with data to calculate Lille score < 0.45 on day 4 (n = 29) or 7 (n = 89) who continued steroids were compared to 83 patients with Lille scores ≥ 0.45 on day 4 (n = 18) or 7 (n = 65) who stopped steroids. The primary outcome was 30-day survival. For comparison, a contemporaneous matched control group was also analyzed of 110 patients who were hospitalized with severe AH, but did not receive steroids.
In patients with Lille score < 0.45, survival was higher at 30-day when compared to those with Lille score ≥ 0.45 (94.9% vs. 80.72%; p = 0.002). The sensitivity, specificity, positive predictive value and negative predictive value of Lille score (< 0.45) to predict 30-day survival was 95%, 19%, 63%, and 73%, respectively.
In severe AH, those with Lille score < 0.45 at day 4 or 7 have improved 30-day survival compared to those with Lille score ≥ 0.45. In those receiving steroids, Lille score has excellent sensitivity to predict 30-day survival but poor specificity.
背景/目的：在酒精性肝炎（AH）中， Lille 评分用于评估类固醇治疗的无效性。然而， Lille 评分预测 AH 患者 30 天生存率的能力尚未明确。本研究旨在比较 Lille 评分在预测接受类固醇治疗的 AH 患者 30 天生存率中的作用。
回顾性分析 2012 年 1 月 1 日至 2019 年 12 月 30 日期间因 AH 住院的 882 例患者的病历。其中 201 例严重 AH 患者符合接受类固醇治疗的标准。在第 4 天（n=29）或第 7 天（n=89） Lille 评分<0.45 且继续接受类固醇治疗的患者中，比较 Lille 评分在第 4 天（n=18）或第 7 天（n=65）≥0.45 且停止类固醇治疗的患者。主要结局为 30 天生存率。此外，还分析了同期因严重 AH 住院但未接受类固醇治疗的 110 例患者作为对照。
在 Lille 评分<0.45 的患者中，30 天生存率高于 Lille 评分≥0.45 的患者（94.9% vs. 80.72%；p=0.002）。 Lille 评分（<0.45）预测 30 天生存率的敏感性、特异性、阳性预测值和阴性预测值分别为 95%、19%、63%和 73%。
在严重 AH 患者中，第 4 天或第 7 天 Lille 评分<0.45 的患者 30 天生存率优于 Lille 评分≥0.45 的患者。在接受类固醇治疗的患者中， Lille 评分对预测 30 天生存率具有很高的敏感性，但特异性较差。
