title: Hepatic artery duplex Doppler ultrasound in severe alcoholic hepatitis and correlation with Maddrey's discriminant function.
abstract: BACKGROUND
  Alcoholic hepatitis is associated with altered hepatic artery hemodynamics. Maddrey's discriminant function (MDF) can identify patients with poor prognosis (DF >32). We studied hepatic artery hemodynamic parameters of hepatic artery diameter (HAD), resistive index (RI) and pulsatility index (PI) in severe acute alcoholic hepatitis (SAAH) and for the presence of correlation of parameters with severity factor MDF.
  
  
  METHODS
  A total of 20 consecutive SAAH patients defined as MDF >32 and a group of 20 alcoholic cirrhosis patients without alcoholic hepatitis formed the two study groups. Hepatic artery Doppler parameters HAD, RI, PI were determined after admission in the Gastroenterology Department, Government Medical College, Thiruvananthapuram, India. MDF score of SAAH was calculated at the time of admission to the hospital.
  
  
  RESULTS
  The mean HAD showed statistically significant increase in SAAH compared with cirrhosis (3.96±0.51 vs. 2.86±0.41, P<0.001). There was statistically significant decrease in mean RI (0.49±0.08 vs. 0.81±0.09, P<0.001) and mean PI (1.67±0.13 vs. 1.80±0.13, P<0.001) in SAAH compared with alcoholic cirrhosis. Statistically significant correlation between MDF and HAD (r=0.63, P<0.003) was found in SAAH. On linear regression, 36% of the variability in MDF could be independently predicted by HAD.
  
  
  CONCLUSIONS
  Hepatic artery parameters of HAD, RI, PI had a significant difference in SAAH compared with alcoholic cirrhosis patients thereby being useful as a diagnostic tool. HAD showed correlation with MDF score assessing the severity of alcoholic hepatitis and may be a useful non-invasive prognostic tool.
authors.affiliation: Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Haridas
authors.initials: H
authors.lastname: Abhilash
authors.affiliation: Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Madhavan
authors.initials: M
authors.lastname: Mukunda
authors.affiliation: Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Premaletha
authors.initials: P
authors.lastname: Sunil
authors.affiliation: Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Krishnadas
authors.initials: K
authors.lastname: Devadas
authors.affiliation: Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Katoor Ramakrishnan Nair
authors.initials: KR
authors.lastname: Vinayakumar
keywords: Alcoholic hepatitis; Maddrey’s discriminant function; duplex Doppler ultrasound; hepatic artery
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