Assessment of prognostic factors in severe alcoholic hepatitis in a tertiary care centre

Severe alcoholic hepatitis is a condition associated with a high risk short-term mortality despite the available therapeutic options and about 50% of patients die within the first two months.This study aimed at evaluating the prognostic factors in severe alcoholic hepatitis by assessing the clinical and laboratory parameters and prognostic scoring models. This was a prospective observational study conducted with 42 patients in Madras Medical College & Rajiv Gandhi Government General Hospital Chennaifrom June 2014 to March 2015. Clinical and laboratory data were collected and prognostic scores were analysed at admission and week 1 and patients were followed up to 28 days. Death occurred in 16.7% of study population within 4 weeks.Of the mortality cases 6 patients (85.7%) had ascites, 6 patients (85.7%) had hepatic encephalopathy, 3 patients had upper gastrointestinal bleeding (42.8%) and 1 patient (14.2%) had infectious complication.Presence of hepatic encephalopathy and hepato renal syndrome was significantly associated with short term mortality. Raised bilirubin value or coexistence of ascites didn’t determine the outcome. Serum alkaline phosphatase, PT (INR), blood urea, serum creatinine and platelets on admission was significantly associated with short term mortality.
SGPT, PT (INR), blood urea, serum creatinine and serum sodium at week 1 was significantly associated with short term mortality. Antibiotic usage and ionotrope usage was significantly associated with short term mortality. All the prognostic models were comparable and significantly determined the short term mortality except for Glasgow alcoholic hepatitis on admission. To conclude in this study presence of encephalopathy, raised urea and creatinine, elevated INR, elevated MELD and ABIC scores were significantly associated with short term mortality in patients with severe alcoholic hepatitis.