Severe AH (SAH) is the most florid presentation of alcohol-related liver disease with high short-term mortality. Steroids have remained the mainstay of therapy despite the controversy. The aim of the present study was to assess the risk factors and compare the severity scores predicting 90 day mortality along with the feasibility of steroids in this sick subset of patients.Methods
All patients with SAH (defined as Discriminant Function ≥32) admitted from January 2015 to February 2017 at our Institute were prospectively enrolled. All patients were given standard treatment according to various guidelines, and their 90 day mortality was determined. Various hematologic, biochemical factors and severity scores were compared between survivors and patients who died.Results
A total of 183 patients (98% males, median age 41 years [range 20–70 years]) were included. The median MELD was 26 (15–40). Ascites was present in 83% and hepatic encephalopathy in 38%. Only 21 (12%) could be offered steroid therapy, due to contraindications in the remaining. By 90 days, only 103 (56%) patients survived while 80 (44%) patients had died. All patients died due to progressive liver failure and its complications. On multivariate analysis presence of ascites, hepatic encephalopathy, high bilirubin, low albumin, high creatinine, high INR, and low potassium independently predicted 90 day mortality. All the scores performed significantly in predicting 90 day mortality with no statistically significant difference between them. MELD score had a maximum area under the curve 0.76 for 90 day mortality (table 1 and figure 1). A combination of Child class and presence of acute kidney injury (creatinine ≥1.35) was good in predicting 90 day mortality.Conclusions
In India, SAH is characterised by a median MELD score of 26 and has a 90 day mortality of 44%. Most Indian patients are not eligible to receive corticosteroids. Presence of Child C status and high serum creatinine value (≥1.35 mg/dL) accurately predicts mortality and is an easy and effective bedside tool to prognosticate the patients at admission. Newer treatment options need to be explored for these patients.