Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2025; 17(2): 102152
Published online Feb 27, 2025. doi: 10.4254/wjh.v17.i2.102152
Predictors and prognosticators of outcomes in alcoholic hepatitis: A retrospective single center study
Kevin Yang, Naren Nallapeta, Nariman Hossein-Javaheri, Alexander Carlson, Brian Quigley, Thomas Mahl
Kevin Yang, Naren Nallapeta, Nariman Hossein-Javaheri, Alexander Carlson, Brian Quigley, Thomas Mahl, Department of Gastroenterology and Hepatology, University at Buffalo, Buffalo, NY 14203, United States
Author contributions: Yang K, Nallapeta N, Hossein-Javaheri N, and Carlson A wrote and edited the article and reviewed the literature; Quigley B contributed the statistical analysis; Mahl T edited the article and is the article guarantor.
Institutional review board statement: The study was reviewed and approved by the University at Buffalo Institutional Review Board (No. STUDY00006976).
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: There are no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at huaxing159357@gmail.com. No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kevin Yang, MD, Physician, Department of Gastroenterology and Hepatology, University at Buffalo, 955 Main St, Buffalo, NY 14203, United States. huaxing159357@gmail.com
Received: October 10, 2024
Revised: November 23, 2024
Accepted: January 15, 2025
Published online: February 27, 2025
Processing time: 133 Days and 4.3 Hours
Abstract
BACKGROUND

Various prognostic scores have been developed to predict mortality and response to steroids in alcoholic hepatitis (AH). We aimed to further validate and compare these scores, particularly pre-day 7 Lille scores, in addition to identifying reliable predictors of complications and mortality such as renal dysfunction and nutritional status.

AIM

To identify predictors of complications and mortality in AH, particularly focusing on demographics, renal involvement, underlying liver disease, and nutrition.

METHODS

This is a retrospective analysis of patients admitted to a large urban tertiary care center with AH from 2020 to 2022. Receiver operating characteristics (ROC) curve analysis was conducted to compare established prognostic scores with Lille scores from day 3 to day 7 (LM3-7). Logistic regression equations were conducted to identify predictor variables.

RESULTS

Severe AH (SAH) as defined by Maddrey’s discriminant function ≥ 32 was diagnosed in 150 out of 425 patients with AH. LM3-7 had 28-day mortality rates in the responder group of 7%-11%, while in the non-responder group, mortality rates were approximately 38%-42%. LM3-7 had 90-day mortality rates in the responder group of 12% to 17%, while in the non-responder group, mortality rates were 48%-53%. Furthermore, all LM3-7 scores showed comparable efficacy in predicting mortality using ROC curve analysis; Area under ROC ranged from 0.771 to 0.802 for 28-day mortality and 0.743 to 0.809 for 90-day mortality. Regarding complications and mortality in AH, significant predictors included poor nutritional status, underlying cirrhosis, and acute renal dysfunction.

CONCLUSION

LM3-6 is as accurate as LM7 in predicting corticosteroid efficacy for 28-day and 90-day mortality in patients with SAH. Holding glucocorticoids early during the disease course can prevent unnecessary complications.

Keywords: Alcoholic liver disease; Alcoholic hepatitis; Acute liver failure; Lille score; Nutrition

Core Tip: Our manuscript evaluates the utility of pre-day 7 Lille scores. Calculating the Lille score as early as day 3 can determine the need for glucocorticoids in patients with severe alcoholic hepatitis and potentially limit the side effects of unnecessary steroid therapy. Day 3-7 Lille scores all show comparable efficacy in predicting response to steroids and mortality.