Alcoholic hepatitis natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
* Poor prognostic factors include: | * Poor prognostic factors include: | ||
*:* [[Ddx:Ascites|Ascites]] | *:* [[Ddx:Ascites|Ascites]] | ||
*:* [[Ddx:Bilirubin|Elevated bilirubin]] | |||
*:* Elevated [prothrombin time]] (PT) | |||
*:* [[Encephalopathy]] | *:* [[Encephalopathy]] | ||
*:* Hepatic fibrosis and [[Cirrhosis|cirrhosis]] | |||
*:* [[Ddx:Leukocytosis|Leukocytosis]] not due to other causes | |||
*:* [[Ddx:Renal Failure|Renal failure]] | *:* [[Ddx:Renal Failure|Renal failure]] | ||
* Discriminant function, as described above, is a predictor or severity. | * 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. | *:* 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. | * [[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. | *:* 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 <cite>#maddrey</cite> described the | * Maddrey, et al <cite>#maddrey</cite> described the Discriminant Function (DF) formula to determine patients who might respond: | ||
*::::: ''DF = 4.6 x (PT – control PT) + Total Bilirubin '' | *::::: ''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. | *:* 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%. | *:* 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 | *:* Effect on long term mortality not clear | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 19:58, 15 February 2013
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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
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Prognosis
- Poor prognostic factors include:
- Ascites
- Elevated bilirubin
- Elevated [prothrombin time]] (PT)
- Encephalopathy
- Hepatic fibrosis and cirrhosis
- Leukocytosis not due to other causes
- Renal failure
- 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