Prevalence of Septic Events, Type 1 Hepatorenal Syndrome, and Mortality in Severe Alcoholic Hepatitis and Utility of Discriminant Function and MELD Score in Predicting These Adverse Events

Abstract

We sought to assess prevalence, and utility of discriminant function (DF) and MELD score in predicting septic events (SE), type 1 hepatorenal syndrome (HRS), and short-term mortality in severe alcoholic hepatitis (AH). Charts of patients with AH (group 1) and cirrhosis without AH (group 2) were retrospectively reviewed. Severe AH, discriminant function (DF) >or= 32 was treated with pentoxifylline. One hundred ninety-five patients were enrolled in the study and divided into 2 groups: group 1, n=99, and group 2, n=96. Of those with AH, 82% had a DF >or= 32 at presentation. Group 1 patients had a higher prevalence of SE (38% versus 25%, P=.04), type 1 HRS (30% versus 9%, P=.0003), and short-term mortality (28% versus 7%, P=.0001). In patients with AH, a MELD score >or=20 (but not a DF >or= 32) at presentation was an independent predictor of a SE (odds ratio [OR] 2.8 [1.0-7.9], P=.04), HRS (OR 4.0, 95% confidence interval [CI] 1.0-16.6, P=0.05), and short-term mortality (OR 6.4, 95% CI 1.1-37.6, P=.03). Kaplan-Meier survival curves confirmed that that a MELD >or= 20 but not a DF >or= 32 was associated with a poorer survival (P = .005 and .5, respectively). In conclusion, patients with severe AH have higher prevalence of SE, HRS, and short-term mortality compared to those with cirrhosis without AH. A MELD score >or=20 at presentation is an independent predictor of these adverse events in patients with AH who have been treated with pentoxifylline.

Recurrent severe alcoholic hepatitis

“…Therefore, the pattern of CS response should be similar between episodes in any one individual, and this is corroborated by this case series, although this requires further confirmation. In B30% of admissions, CS were precluded because of infections, consistent with earlier studies in which the prevalence of infections in AH varied from 38 to 49.3% [13,29,30]. Unfortunately, those with infections are often the sickest and such patients arguably have the greatest need for safe and effective medical therapy.…”

Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome

“…Paradoxically, despite data suggesting neutrophil priming, it is also established that patients with alcoholic cirrhosis, especially those with AH, are prone to infections, 28 with a higher prevalence of sepsis, 29 and are more likely to die from sepsis-related complications. 14 This clinical finding is supported by several studies showing defects in phagocytosis, bactericidal capacity, chemotaxis, and neutrophil locomotion.…”

Model for End-stage Liver Disease

“…Six studies have compared MELD and discriminate function index (DFI) scores amongst AH patients. MELD was similar to DFI for predicting 30 day mortality in 3 studies (c-statistic of 0.82, 0.73, and 0.89 for MELD >11, 21, and 18 vs. 0.86, 0.69, and 0.81 respectively for DFI >32 [71][72][73] ); superior to DFI in 2 studies in predicting 30 day mortality (0.83 for MELD >22 vs. 0.74 for DFI >41 74 or occurrence of complications of liver disease in one study 75 ); and inferior to DFI in one study. 76 Three studies comparing MELD and CTP showed 2 scores to be similar for mortality during the hospital stay 72 or at 3 and 6 months 6 while in the third study, CTP but not MELD was predictor of 90 day mortality.…”