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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

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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) ≥ 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 ≥ 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 ≥20 (but not a DF ≥ 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 ≥ 20 but not a DF ≥ 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 ≥20 at presentation is an independent predictor of these adverse events in patients with AH who have been treated with pentoxifylline.

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Acknowledgment

This study was partly funded by a research grant from the Liver and Research Education Foundation (LREF) at Rancho Los Amigos Center. The research grant was made available to S.V. by a donation from the late Dr Telfer Reynolds.

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  1. Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, 90033, USA

    Sumita Verma, Ketan Ajudia, Michel Mendler & Allan Redeker

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  1. Sumita Verma
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  2. Ketan Ajudia
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  3. Michel Mendler
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  4. Allan Redeker
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Correspondence to Sumita Verma.

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Verma, S., Ajudia, K., Mendler, M. et al. 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. Dig Dis Sci 51, 1637–1643 (2006). https://doi.org/10.1007/s10620-006-9099-z

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