Main clinical factors influencing early mortality in a cohort of patients with severe alcoholic hepatitis, and evaluation trough ROC curves of different prognostic scoring systems

Autores: Higuera de la Tijera Fatima, Servín Caamaño Alfredo Israel, Pérez Torres Eduardo, Salas Gordillo Francisco, Abdo Francis Juan Miguel, Pérez Hernández José Luis, Kershenobich Stalnikowitz David

Resumen

Background: Severe alcoholic hepatitis (SAH) presents high early mortality-rate (90 days) and is related to several complications. The aim of this study was to evaluate the impact on early mortality-rate of developed complications in patients with SAH, and to evaluate the accuracy of different prognostic scoring systems to predict early mortality. Subjects and methods: Cohort study. Were included 110 patients with SAH. We collected data about development of complications: acute renal failure (ARF), hepatic encephalopathy (HE), variceal bleeding (VB), infections; alcohol intake (g/day) and presence of cirrhosis by ultrasonography (USG). Child-Pugh, Maddrey¡¯s modified discriminant function (DF), Model for End stage Liver Disease (MELD); Age, Bilirubin, INR, and Creatinine score (ABIC); Lille score, and Glasgow Alcoholic Hepatitis Score (GAHS) were calculated. Primary endpoint was 90-day mortality. To evaluate survival according to the development of complications we performed a Cox regression model. Accuracy of different prognostic scoring systems was evaluated trough ROC curves. Results: 90-day mortality-rate was 71 patients (64.5%). 79 patients (71.8%) had evidence of cirrhosis in the USG, 59 (53.6%) developed HE, 54 (49.1%) ARF, 41 (37.3%) VB, and 41 (37.3%) infection. In the Cox-regression model significant association was found between greater risk of mortality and the development of HE (HR 8.0; IC al 95% 3.0 a 21.4; P = 0.0001) and presence of cirrhosis in the USG (HR 3.0; 95% CI 1.0 to 8.7; P = 0.045). Regard to prognostic scoring systems we found that Lille score ¡Ý 0.45 was the best predictor of early mortality in patients with SAH (AUROC = 0.83; 95% CI 0.75 to 0.91, P < 0.0001). Conclusions: The development of HE is the main factor associated to early mortality. Coexistence of cirrhosis is a factor that worsen the prognosis. Lille score is the most accurate for predict early mortality.

Palabras clave: Severe alcoholic hepatitis; mortality; clinical factors; prognostic scoring systems; Lille score; accuracy.

2015-02-12   |   1,226 visitas   |   Evalua este artículo 0 valoraciones

Vol. 77 Núm.4. Octubre-Diciembre 2014 Pags. 160-166 Rev Med Hosp Gen Mex 2014; 77(4)