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 20 January 2018

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Predicting response to corticosteroids and mortality in severe alcoholic hepatitis

A day-4 Lille Model predicts response to corticosteroids and mortality in severe alcoholic hepatitis, reports this month's American Journal of Gastroenterology.

News image

Prednisolone therapy increases the risk of infections in patients with severe alcoholic hepatitis. 

Dr Mauricio Garcia-Saenz-de-Sicilia and colleagues from Arkansas, USA evaluated whether the use of the Lille Model at day 4 is useful to predict response to prednisolone compared with the classic day 7 in order to limit a futile exposure to corticosteroids.

The research team performed a retrospective analysis of a large multinational cohort of patients with severe alcoholic hepatitis with Maddrey’s discriminant function ≥32. 

The team assessed response to corticosteroids with Lille Model at day 4 and 7, according to the validated cutoff value. 

A total of 63% of 260 patients received corticosteroids
American Journal of Gastroenterology
Receiver operating characteristics curves were constructed to determine the optimal cutoff value for Lille Model at day 4, and to compare accuracy between Lille Model at day 4, Lille Model at day 7, MELD (Model for End-Stage Liver Disease), and ABIC (age, bilirubin, international normalized ratio, and creatinine).
 
The team predicted 28- and 90-day mortality, and assessed long-term survival.

The researchers reported that a total of 63% of 260 patients received corticosteroids.

The team found that the median discriminant function for the patients treated with corticosteroids was 64. 

Overall 90-day mortality was 36%. 

The research team observed that the median Lille Model at day 4 and 7 for the patients who received treatment was 0.39, and 0.36. 

Lille Model at day 4 was a strong independent predictor of 28-day mortality. 

By using Lille Model at day 4 with a cutoff >0.45, the team noted that 28- and 90-day survival was significantly higher for responders than non-responders. 

Importantly, the area under the curve for predicting mortality for LM4 was similar than the classic Lille Model at day 7.

Dr Garcia-Saenz-de-Sicilia's team concludes, "Lille Model at day 4 is as accurate as at day 7 in predicting response to corticosteroids, as well as 28- and 90-day mortality."

'Assessing the efficacy of prednisolone at an earlier time point can avoid a more prolonged futile use of this therapy."

Am J Gastroenterol 2017; 112:306–315
22 February 2017

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