Publication:

Clinical determinants of thirty-day mortality in a cohort of patients with severe alcoholic hepatitis

Background Aim and objectives was to study clinical profile of patients with severe alcoholic hepatitis (SAH) and evaluate clinical factors associated with short term (30-day) mortality.

Methods This is a prospective study conducted from January 2016 to January 2017 at Liver Care Unit, Osmania General Hospital. This study was approved by ethics committee of the hospital and written informed consent was obtained from all subjects included in the study. Patients with clinical alcoholic hepatitis with serum bilirubin >5mg/dl, aspartate amino transferase (AST)/ alanine amino transferase (ALT) ratio >2 with an AST level >45 but <500U/L, Maddrey’s Discriminant function (MDF) ≥32 were included in the study.

Results The 30-day mortality of severe AH in the current study was 40%. Alcoholic hepatitis was most common in males between 40-50 years with a median age of 46.9±7.7 (31-60) years. The clinical complications consisted of hepatic encephalopathy (HE) in 40%, hepato renal syndrome (HRS) and renal failure in 18.2% and infections in 40%. HRS, bilirubin, ALT, AST, urea, creatinine, Na+ and all prognostic scores showed significant association with in hospital mortality at 30days on univariate analysis while United Kingdom end liver disease (UKELD) and Child-Turcotte-Pugh (CTP) scores showed most significance on multivariate regression analysis.

Conclusions The 30-day mortality of severe AH in the current study was 40%. High UKELD, CTP scores and presence of HRS/Renal dysfunction at time of admission are associated with high 30-day mortality. Patients with advanced age, decompensated cirrhosis, coagulopathy, renal injury, malnourished status and low sodium respond poorly to therapy.