Article Text

Download PDFPDF

PTU-133 Predicting Mortality In Alcholic Hepatitis; A Comparison In Different Scoring Systems
  1. SK Sidhu,
  2. C Reddick,
  3. A Turner,
  4. K Mcwhirter,
  5. A Al-Rifai
  1. Salford Royal Hospital, Manchester, UK


Introduction Alcoholic hepatitis is a severe presentation of alcoholic liver disease. In its most severe form (with a Maddray score >32) the 1 month mortality is 35%. There are currently a few methods used to decide if continuation of corticosteroid therapy is beneficial, the Lille’s Score and the presence of a 25% reduction in the serum bilirubin between day 1 and day 7. We assess the effectiveness of these scoring systems in assessing 6 month mortality.

Methods All patients admitted with a diagnosis of alcoholic hepatitis with a Maddray score > 32 with no evidence of sepsis over a 2 year period (2010–2012) were identified. All the notes were analysed and data collected by a F1 using a standardised profroma. Patients were placed into 4 groups: Group 1= <25% reduction in bilirubin, low Lille score, Group 2= <25% in bilirubin, high Lille score, Group 3= >25% reduction in bilirubin, low Lille score and Group 4= >25% reduction in bilirubin, high Lille score.

Results Overall 77 patients were included, at 6 months 21 died (27%). The mean age was 48 yrs (Range 27–67 years). At day 1 there was biochemical parameters consistent with significant liver disease (Madray Score: 68 (Range 34–169), Albumin 29.9 ± 4.9, INR: 2.0 ± 0.5, Bilirubin: 235 ± 135). 77 (100%) patients received nutritional support, Vitamin B and Thiamine. The baseline INR (Alive: 1.85 ± 0.47, Died: 2.31 ± 0.59 p = 0.001) and Albumin (Alive: 30.6 ± 4.6, Died: 28.1 ± 5.5 p = 0.04) were significantly deranged in patients who died at 6 months. There was no significant difference in the baseline Urea (Alive: 3.81 ± 3.54, Died: 4.26 ± 3.46 p = 0.610), Creatinine (Alive: 64.3 ± 45.9, Died: 79.5 ± 59.6 p = 0.232) and Bilirubin (Alive: 237.8 ± 144.6, Died: 228.1 ± 110.3 p = 0.779) in patients who died at 6 months.

There were no patient that fell into group 4. In the other 3 groups there were similar numbers of patients (Group 1: 29 patients, 6 month mortality 17%, Group 2: 23 patients, 6 month mortality 57%, Group 3: 25 patients, 6 month mortality 12%). Kaplan Meier survival curves were created for these 3 groups and is shown in Figure 1 below.

Abstract PTU-133 Figure 1

Kaplan-Meier survival curve at 6 months post admission

Conclusion In this study factors suggesting poor liver synthetic function (INR and Albumin) were associated with 6 month mortality. There was a significantly worse outcome with a high Lille score compared to a low Lille score. There was very little effect of a greater than 25% reduction in bilirubin on mortality at 6 months. From this study we would suggest that the Lille score is used to accurately predict a poor outcome.

Disclosure of Interest None Declared.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.