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News

Scoring systems for the management of alcoholic hepatitis

A prospective study reported in the latest issue of 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 of the Glasgow Alcoholic Hepatitis Score, the Discriminant Function, Model for End-Stage Liver Disease and the age, bilirubin, INR and creatinine scores as well as scores to assess corticosteroid response in the management of alcoholic hepatitis.

A total of 182 patients were studied prospectively.

The Glasgow Alcoholic Hepatitis Score, Model for End-Stage Liver Disease, age, bilirubin, INR and creatinine and DF scores were recorded 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.

Response to corticosteroids can be assessed using the Lille Score
Alimentary Pharmacology & Therapeutics

The research team found no differences in outcome between favourable scores as per recommended cut-off points.

Patients with a Glasgow Alcoholic Hepatitis Score less than 9 had similar outcome whether their Model for End-Stage Liver Disease, Discriminant Function or age, bilirubin, INR and creatinine scores were favorable or unfavorable.

The doctors observed that treated patients with a Glasgow Alcoholic Hepatitis Score of 9 had a significantly better 90-day outcome than those who did not.

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

The 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 of 9 identified patients who may benefit from treatment of alcoholic hepatitis."

"Intention-to-treat randomized-controlled trials using a Glasgow Alcoholic Hepatitis Score of 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): 603610
20 September 2013

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