Clinical characteristics and prognosis of patients with severe alcoholic hepatitis

Abstract

Abstract: Objective To review the clinical data of severe alcoholic hepatitis (SAH) patients, and compare the clinical features, prognosis scores and short-term prognosis of non-SAH- acute-on-chronic liver failure (ACLF) and SAH-ACLF patients, so as to provide basis for SAH disease management, prognosis evaluation and treatment strategy formulation. Methods From January 2009 to October 2021, 112 patients with SAH [105 males and 7 females, aged (49.6±9.4) years] were collected. Patients with SAH were divided into non-SAH-ACLF group and SAH-ACLF group according to whether there was ACLF. We compared the clinical features, prognosis scores and 28-day and 90-day survival rates between patients in two groups. The measurement data of skewness distribution was expressed as [M (P₂₅, P₇₅)], and Mann-Whitney U test was adopted. The measurement data of normal distribution was expressed as (±s), and independent t test was adopted. Counting data were expressed as absolute numbers, which were compared by Chi-square test. The survival rate was compared by Log-Rank test. Results There were 82 and 30 patients without SAH-ACLF and with SAH-ACLF, respectively. According to the clinical characteristics, 9 cases (11.0%), 8 cases (9.7%), 19 cases (23.2%) and 27 cases (32.9%) of gastrointestinal bleeding, hepatic encephalopathy, infection and ascites in non-SAH-ACLF group, which were compared with SAH-ACLF group [8 cases (26.7%), 16 cases (53.3%), 17 cases (56.7%) and 20 cases (66.7%)], with statistical significance (χ²=-4.200, -24.733, -11.299, -10.267, P<0.05). White blood cells (WBC), total bilirubin (TBil), direct bilirubin (DBil), urea nitrogen (BUN) and creatinine (Scr) in patients without SAH-ACLF were 7.0 (4.6, 10.8) × 10⁹/L, 140.6 (98.4, 302.8) μmol/L, 82.0 (44.4, 172.5) μmol/L, 4.8 (3.1, 6.5) mmol/L and 58.4 (52.0, 76.5) μmol/L, compared with those in SAH-ACLF group [9.4 (6.5, 14.5) × 10⁹/L, 242.8 (186.0, 412.6) μmol/L, 162.5 (92.5, 231.8) μmol/L, 9.2 (4.0, 15.4) mmol/L and 91.4 (65.4, 220.6) μmol/L, with statistical significance (Z=-3.914, -10.126, -11.020, -10.104, -8.002, P<0.05). The prothrombin time (PT) and international normalized ratio (INR) of non-SAH-ACLF group were 20.2 (19.0, 23.6) s and 1.6 (1.5, 2.0), which were significantly higher than those of SAH-ACLF group [26.5 (21.5, 32.2) s and 2.2 (1.8, 2.0), Z=-3.802, -3.914, P<0.05]. The Maddrey discriminant function (MDF) score, model for end-stage liver disease (MELD) score, Age-bilirubin-INR-creatinine (ABIC) score, chronic liver failure-sequential organ failure (CLIF-SOFA) score, chronic liver failure-Consortium Organ Failure score (CLIF-C OFs) and CLIF-C ACLF score of non-SAH-ACLF patients were 52.0 (41.5, 68.4) points, 11.2 (9.0, 14.2) points, 7.4 (6.0, 9.0) points, (7.4. 9.0) points, 4.0 (3.0, 5.0) points, 8.0 (7.0, 9.0) points and 35.4 (30.2, 42.5) points, compared with those in SAH-ACLF group [82.0 (56.2, 108.0) points, 20.8 (15.5, 25.4) points, 8.8 (7.5, 10.6) points, 6.0 (5.0, 8.0) points, 10.0 (9.0, 11.0) points and 48.0 (40.0, 52.1) points], with statistical significance (Z=2.664, 6.508, 2.251, 2.610, 2.412, 5.268, P<0.05). The 28-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 95.1% (78/82) and 70.0% (21/30), with statistical significance (χ²=11.511, P<0.05). The 90-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 84.1% (69/82) and 46.7% (14/30), with statistical significance (χ²=16.079, P<0.05). Conclusion Compared with SAH patients without ACLF, complications, blood biochemical indexes and prognosis scores after ACLF are significantly worse than the former, and the short-term prognosis is obviously unsatisfactory, which needs to be paid attention to in clinical practice.

Key words: Severe alcoholic hepatitis, Acute-on-chronic liver failure, Maddrey discriminant function score, Chronic liver failure-sequential organ failure score

LI Xiang-yang, TANG Quan-miao, WANG Lei. Clinical characteristics and prognosis of patients with severe alcoholic hepatitis[J]. Chinese Hepatolgy, 2022, 27(5): 584-587.

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