Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis treated with prednisolone.
Early identification of patients with severe (discriminant function >or=32) biopsy-proven alcoholic hepatitis (AH) who are not responding to corticosteroids would be clinically relevant. Our goal was to develop simple criteria that will help physicians to promptly identify nonresponders to corticosteroids. A total of 238 patients were included. We used 6 months survival as an end point because of the rule requiring 6 months for listing alcoholic patients for transplantation. Overall survival at 1 and 6 months was 85% +/- 2.3% and 64.3% +/- 3.3%, respectively. An early change in bilirubin levels (ECBL) at 7 days (defined as bilirubin level at 7 days lower than bilirubin level on the first day of treatment) was observed in 73% of patients. At 7 days, in patients with ECBL, bilirubin decreased (84 +/- 75 micromol/L [4.94 +/- 4.40 mg/dL]), whereas it increased in patients without ECBL (76.5 +/- 77 micromol/L [4.50 +/- 4.54 mg/dL], P <.0001). Ninety-five percent of patients with ECBL continued to have improved liver function during treatment. At 6 months, survival of patients with ECBL was significantly higher than that of patients without ECBL, 82.8% +/- 3.3% versus 23% +/- 5.8%, P <.0001. On multivariate analysis, ECBL, discriminant function and creatinine were independent prognostic variables, and ECBL had the most important prognostic value. In conclusion, ECBL is a very simple predictive factor for identifying nonresponders. A recommendation to discontinue corticosteroids after 7 days in patients without ECBL, suggested by our results, awaits additional confirmation.
Mathurin
Philippe
P
Sce d'Hépato-Gastroentérologie, Hôpital Claude Hurriez, and Inserm EPI 0114 Lille, Paris, France. p.mathurin@chru-lille.fr
Abdelnour
Marcelle
M
Ramond
Marie-José
MJ
Carbonell
Nicolas
N
Fartoux
Laetitia
L
Serfaty
Lawrence
L
Valla
Dominique
D
Poupon
Raoul
R
Chaput
Jean-Claude
JC
Naveau
Sylvie
S
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis
D011239:Prednisolone; D001663:Bilirubin