Scoring Systems for Alcoholic Hepatitis = Scoring Systems for Alcoholic Hepatitis

다국어 초록 (Multilingual Abstract)

Alcoholic hepatitis is associated with a high risk of short-term mortality, between 30-50% at 3 months. Alcoholic hepatitis hasbeen associated with multi-organ failure when superimposed on chronic liver disease, a condition more recently termed, “acuteon chronic liver failure”. Management of the patient with alcoholic hepatitis requires intensive care in those with multiple organfailure; specific treatments aimed at reversing the hepatic injury; and interventions towards alcohol rehabilitation. Corticosteroidsimprove survival at 28 days, though the magnitude of benefit may not be as large as previously believed. Among those patientswho respond to steroids, complete abstinence from alcohol is associated with improved survival at one year. No medical therapyalone is associated with improved survival beyond 6 months, and liver transplantation remains the best option for patients withliver failure who are rehabilitated from alcohol abuse. There is a subset of patients in whom all interventions, either medicalor psychosocial, are futile.In patients with alcoholic hepatitis, the risk for mortality is related to severity of liver disease, the attending complications ofinfection and multiple-organ failure, inflammatory response, histology, risk for continued alcohol abuse, and perhaps geneticpolymorphisms. Identifying whether the course of implemented therapy is having the intended effect is also critical so that thetherapy and its inherent toxicities can be obviated if a benefit is unlikely to be conferred. Such is the example with corticosteroidtherapy whereby initial studies showed that a lack of improvement in bilirubin after one week of therapy indicated futility. Thereis, therefore, the need for accurate risk scores to stratify patients for mortality at both baseline state and at interval times afterinitiation of therapy.Mathurin and colleagues combined static scores (MDF, MELD and ABIC) with a dynamic score (Lille) to determine which combinationhad the best prognostic value. They concluded that the MELD + Lille combination was significantly better than the MDF+ Lille, or ABIC + Lille score in predicting patient survival.