Alcoholic hepatitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S

Natural history, Complications and Prognosis

Prognosis

• Poor prognostic factors include:

  • Leukocytosis not due to other causes
  • Hepatic fibrosis and cirrhosis
  • Ascites
  • Encephalopathy
  • Renal failure
  • Elevated bilirubin
  • Elevated prothrombin time (PT)

• Discriminant function, as described above, is a predictor or severity.

  • DF > 32 – Mortality 35% without steroids, in patients without encephalopathy. Mortality 45% in patients with encephalopathy.

• Abstinence appears to help slow or stop the progression of alcohol associated liver disease.

  • In patients with advanced disease, cirrhosis can develop in patients who stop, but is much more likely to develop in those patients who continue to drink.

• Maddrey, et al #maddrey described the Discriminant Function (DF) formula to determine patients who might respond:

  DF = 4.6 x (PT – control PT) + Total Bilirubin

  • DF > 32 has been been associated with a high death rate, up to 50% in some studies, with improved prognosis with steroid treatment.
  • A recent study showed a fall in one month mortality from 35 to 6%. Another showed a fall in six month mortality 55 to 16%.
  • Effect on long term mortality not clear