A Clinical Study of Spectrum of Alcoholic Liver Diseases With Respect to Predictors of Severity and Prognosis

Abstract

BACKGROUNDChronic and excessive alcohol ingestion is one of the major causes of liver disease. The traditional disease specific prognostic model used for this purpose is the Maddrey Discriminant Function (DF). MELD score has been recently developed to predict mortality in patients with alcoholic hepatitis.This study aims at correlating MELD score, serum sodium, MELD NA score, serum albumin and Maddrey discriminant function in determining short-term prognosis in patients with alcoholic liver disease and its complications. MATERIALS AND METHODSA total number of 100 patients of age >18 years with significant history of alcohol abuse who were admitted in ESIC, PGIMSR, Bengaluru, with alcoholic liver disease or related complications who met the inclusion and exclusion criteria were analysed. MELD, DF, MELD NA were calculated at admission and correlated with severity and mortality. RESULTSThere were 16 deaths in the study attributable to alcoholic hepatitis or its complications. We found that DF largely correlates with MELD at lower values; at higher values, many patients have disproportionally higher MELD score compared to DF. Among these patients, deaths appear to track more closely with MELD rather than DF. CONCLUSIONIn summary, MELD and MELD NA are useful for predicting 30-day mortality in patients with alcoholic hepatitis and maintains some practical and statistical advantages over DF in predicting mortality rate in these patients. The MELD NA score performed better than MELD in predicting short-term mortality. Presence of ascites, hyponatraemia, hepatic encephalopathy, variceal bleeding and SBP were independent predictors of adverse prognosis in alcoholic hepatitis/cirrhosis. KEYWORDSALD, MELD, DF, MELD NA, Hyponatraemia, ROC and AUROC.HOW TO CITE THIS ARTICLE: Nalapur VT, Basavaiah R. A clinical study of spectrum of alcoholic liver diseases with respect to predictors of severity and prognosis. J. Evid. Based Med.