Kulkarni Anand V, Venishetty Shantan, Kumar Karan, Gurav Nitish, Albhaisi Somaya, Chhabbra Prateek, Shaik Sameer, Alla Manasa, Iyengar Sowmya, Sharma Mithun, Rao Padaki N, Arab Juan P, Reddy Duvvur N
Department of Hepatology, AIG Hospitals, Hyderabad, India.
Department of Hepatology, Mahatma Gandhi Medical College, Jaipur, India.
Intern Med J. 2025 Jan;55(1):109-116. doi: 10.1111/imj.16562. Epub 2024 Oct 27.
Severity scores, including the model for end-stage liver disease (MELD) and discriminant function score, guide the treatment of patients with severe alcohol-associated hepatitis (AH). We aimed to investigate the impact of functional status on outcomes of patients with AH.
Medically managed patients (n = 133) with AH from 1 January 2019 to 31 December 2022 were included in this prospective study. The objectives were to compare the long-term survival, recompensation rates, corticosteroid response, incidence of infections, hepatic encephalopathy (HE) and acute kidney injury (AKI) among propensity score-matched patients with good Karnofsky performance status (KPS) (score ≥50) and poor KPS (score <50) using Kaplan-Meier analysis.
Twenty-five patients with good KPS were matched with 25 patients with poor KPS and followed up for a median duration of 10 (0.5-33) months. Survival was 76% (19/25; 95% confidence interval (CI), 54.9-90.6) in patients with good KPS compared to 42.3% (11/25; 95% CI, 23.4-63.1) patients with poor KPS (P = 0.001) at 10 months. The recompensation rate was higher in the good KPS group than in the poor KPS group (68% vs 44%; P = 0.04). A higher proportion of patients in the good KPS group (78.9%) than in the poor KPS group (42.8%; P = 0.03) responded to corticosteroids. Survival was lower among non-responders in the poor KPS group (0% vs 75%; P = 0.01). The proportion of patients who developed infection (36% vs 28%; P = 0.051), HE (36% vs 12%; P = 0.01) and AKI (60% vs 16%; P < 0.001) was higher in patients with poor KPS than in good KPS.
KPS is an important determinant of outcomes in patients with AH, including survival, recompensation, response to corticosteroids and complications.
严重程度评分，包括终末期肝病模型（MELD）和判别函数评分，指导严重酒精性肝炎（AH）患者的治疗。我们旨在研究功能状态对AH患者预后的影响。
本前瞻性研究纳入了2019年1月1日至2022年12月31日接受药物治疗的133例AH患者。目的是使用Kaplan-Meier分析比较倾向评分匹配的卡诺夫斯基表现状态（KPS）良好（评分≥50）和KPS较差（评分<50）的患者的长期生存率、肝功能恢复率、皮质类固醇反应、感染发生率、肝性脑病（HE）和急性肾损伤（AKI）。
25例KPS良好的患者与25例KPS较差的患者匹配，中位随访时间为10（0.5 - 33）个月。10个月时，KPS良好的患者生存率为76%（19/25；95%置信区间（CI），54.9 - 90.6），而KPS较差的患者生存率为42.3%（11/25；95%CI，23.4 - 63.1）（P = 0.001）。KPS良好组的肝功能恢复率高于KPS较差组（68%对44%；P = 0.04）。KPS良好组中对皮质类固醇有反应的患者比例（78.9%）高于KPS较差组（42.8%；P = 0.03）。KPS较差组中无反应者的生存率较低（0%对75%；P = 0.01）。KPS较差的患者发生感染（36%对28%；P = 0.051）、HE（36%对12%；P = 0.01）和AKI（60%对16%；P < 0.001）的比例高于KPS良好的患者。
KPS是AH患者预后的重要决定因素，包括生存、肝功能恢复、对皮质类固醇的反应和并发症。
