Prognostic Indexes for Alcoholic Hepatitis
Alcohol abuse is the major source of liver disease. The prevalence of alcoholic hepatitis (AH) is unknown, but histologic studies demonstrated that AH may be present in approximately 10% to 35% of hospitalized patients with alcoholism. The assessment of severity permits the identification of patients that will improve without medical therapy and those that will have a high mortality if not treated. A variety of scoring systems has been used to quantity the severity of AH and guides its treatment.
The scores more commonly used are: Maddrey’s discriminant function (DF), Model for End-Stage Liver Disease (MELD), Glasgow Alcoholic Hepatitis Score (GAHS) and Age, serum Bilirubin, INR (International Normalized Ratio), and serum Creatinine (ABIC). Some others prognostic indexes assess the efficacy of treatment, like Lille score, and Early Change in Bilirubin Levels. Histologic findings are showed to predict additional findings like risk of infection and poor prognosis even in a subgroup considered of better prognosis.
The authors strongly recommend liver biopsy to confirm the diagnosis of AH and to discriminate patients with risk of infection and death without medical therapy. In our point of view, this method has been showed to be the best prognostic markers for AH in nowadays. In conclusion, AH is a severe complication among heavy drinkers and frequently results in poor short term prognosis. Various clinical scores are useful to differentiate patients with high mortality if not treated and are similar in predicting the outcome. More recently, the liver biopsy and a histologic score including fibrosis, megamitochondria, neutrophil infiltration and bilirubinostasis showed promising results and should be recommended.
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