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 10 December 2016

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News

Scoring systems for the management of alcoholic hepatitis

The latest issue of the Alimentary Pharmacology & Therapeutics compares scoring systems for the management of alcoholic hepatitis.

News image

The assessment of alcoholic hepatitis remains controversial.

Several scores have been developed or used for this purpose.

Dr Lafferty and colleagues from the United Kingdom used the Glasgow Alcoholic Hepatitis Score, the Discriminant Function, Model for End-Stage Liver Disease and the ABIC scores, as well as scores to assess corticosteroid response in the management of alcoholic hepatitis.

A total of 182 patients were studied prospectively.

The team recorded the Glasgow Alcoholic Hepatitis Score, Model for End-Stage Liver Disease, ABIC and DF scores on admission and serially over the first week of hospital management.

Treatment with corticosteroids or pentoxifylline was considered if the Glasgow Alcoholic Hepatitis Score was 9.

Patients treated with corticosteroids who had a fall in bilirubin of 25%
Alimentary Pharmacology & Therapeutics

There were no differences in outcome between favorable scores as per recommended cut-off points.

The doctors noted that patients with a Glasgow Alcoholic Hepatitis Score less than 9 had similar outcome whether their Model for End-Stage Liver Disease, DF or ABIC scores were favorable or unfavorable.

Treated patients with a Glasgow Alcoholic Hepatitis Score of 9 had a significantly better 90-day outcome than those who did not, at 58% and 30% respectively.

Patients treated with corticosteroids who had a fall in bilirubin of 25% after a week of treatment had an improved survival.

The team found that Lille Score or a 25% fall in bilirubin had greater sensitivities than an early change in bilirubin level to assess treatment response.

Dr LAfferty's team concludes, "In this single-centre study, a Glasgow Alcoholic Hepatitis Score 9 identified patients who may benefit from treatment of alcoholic hepatitis."

"Intention-to-treat randomised-controlled trials using a Glasgow Alcoholic Hepatitis Score =9 as the threshold for treatment are needed to validate these findings."

"Response to corticosteroids can be assessed using the Lille Score or by a 25% fall in bilirubin."

Aliment Pharmacol & Ther 2013: 38(6) 603–610
30 August 2013

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