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Indian Journal of Gastroenterology

, Volume 37, Issue 2, pp 141–152 | Cite as

Predictors of 90-day mortality in patients with severe alcoholic hepatitis: Experience with 183 patients at a tertiary care center from India

  • Ravi Daswani
  • Ashish Kumar
  • Shrihari Anil Anikhindi
  • Praveen Sharma
  • Vikas Singla
  • Naresh Bansal
  • Anil Arora
Original Article

Abstract

Background

Severe alcoholic hepatitis (AH) is not an uncommon indication for hospital admission in India. However, there is limited data from India on predictors of mortality in patients of severe AH. We analyzed the data on patients with severe AH admitted to our institute and compared various parameters and severity scores in predicting 90-day mortality.

Methods

In this prospective study, we analyzed patients with severe AH (defined as discriminant function ≥ 32) admitted from January 2015 to February 2017 to our institute. All patients were administered standard treatment according to various guidelines, and their 90-day mortality was determined. Various hematologic, biochemical factors, and severity scores were compared between survivors and patients who died.

Results

A total of 183 patients (98% males, median age 41 years [range 20–70 years]) were included in our study. The median model for end-stage liver disease (MELD) was 26 (15–40). Ascites were present in 83% and hepatic encephalopathy in 38%. Only 21 (12%) could be offered steroid therapy, due to contraindications in the remaining. By 90 days, only 103 (56%) patients survived while 80 (44%) died. All patients died due to progressive liver failure and its complications. On multivariate analysis, presence of ascites, hepatic encephalopathy, high bilirubin, low albumin, high creatinine, high INR, and low potassium independently predicted 90-day mortality. All the scores performed significantly in predicting 90-day mortality with no statistically significant difference between them. MELD score had a maximum area under the curve 0.76 for 90-day mortality. A combination of Child class and presence of acute kidney injury (creatinine ≥ 1.35) was good in predicting 90-day mortality.

Conclusion

Our patients had severe AH characterized by a median MELD score of 26 and had a 90-day mortality of 44%. Most patients were not eligible to receive corticosteroids. Presence of Child C status and high serum creatinine value (≥ 1.35 mg/dL) accurately predicted mortality. Newer treatment options need to be explored for these patients.

Keywords

Alcoholic hepatitis Alcoholic liver disease Corticosteroids Liver failure Pentoxifylline 

Notes

Acknowledgements

This study did not receive any specific funding.

Compliance with ethical standards

Conflict of interest

RD, AK, SAA, PS, VS, NB, and AA declare that they have no conflicts of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

The Ethics Committee of the hospital approved the study, and the study conformed to the Helsinki declaration of 1975 as revised in 1983.

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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Sir Ganga Ram HospitalInstitute of Liver, Gastroenterology, and Panceatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education and ResearchNew DelhiIndia

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