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
Overview
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