Maiwall et al identified risk factors for mortality of a patient with severe alcoholic hepatitis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Institute of Liver and Biliary Sciences in New Delhi and Command Hospital in Kolkata, India.
Patient selection: severe alcoholic hepatitis with hospitalization, with discriminant function (DF) of Carithers et al (modified Maddrey) >= 32
Exclusions: alcohol-related decompensated chronic liver disease, pre-existing AKI or renal insufficiency, malignancy and advanced cardiopulmonary disease
Outcome: 90-day mortality
Two models were developed based on multivariate Cox regression analysis.
Risk factors from first model:
(1) SIRS on admission (odds ratio 2.0)
(2) elevated MELD score (odds ratio 1.1): nonsurvivors had scores 23.4 +/- 4.3; survivors had scores 20.5 +/- 4.8
(3) AKI progression (odds ratio 1.5)
where:
• SIRS on admission was associated with both development and progression of AKI.
• A high MELD on admission was a significant predictor of AKI progression.
• Mortality was worse with 3 or 4 SIRS components versus 2 components.
Risk factors from second model:
(1) elevated MELD score (odds ratio 1.1)
(2) bacterial infection
