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Am J Gastroenterol. 2017 Feb;112(2):306-315. doi: 10.1038/ajg.2016.539. Epub 2016 Dec 6.

A Day-4 Lille Model Predicts Response to Corticosteroids and Mortality in Severe Alcoholic Hepatitis.

Author information

1
Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
2
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
3
Vall d'Hebron Institut de Reserca, São Paulo, Brazil.
4
Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), São Paulo, Brazil.
5
Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
6
Liver Unit Hospital Clinic, Barcelona, Spain.
7
Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
8
Division of Biochemistry, Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA.

Abstract

OBJECTIVES:

Prednisolone therapy increases the risk of infections in patients with severe alcoholic hepatitis (SAH). We evaluated whether the use of the Lille Model at day 4 (LM4) is useful to predict response to prednisolone compared with the classic day 7 (LM7) in order to limit a futile exposure to corticosteroids.

METHODS:

We performed a retrospective analysis of a large multinational cohort of patients with SAH with Maddrey's discriminant function (DF) ≥32. Response to corticosteroids was assessed with LM4 and LM7, according to the validated cutoff value (CUV>0.45). Receiver operating characteristics (ROC) curves were constructed to determine the optimal CUV for LM4 and to compare accuracy between LM4, LM7, MELD (Model for End-Stage Liver Disease), and ABIC (age, bilirubin, international normalized ratio, and creatinine). Logistic regression models were constructed to predict 28- and 90-day mortality. Cox regression analysis was performed to assess long-term survival.

RESULTS:

A total of 163 (62.7%) out of 260 patients received corticosteroids. The median DF for the patients treated with corticosteroids was 64.1 (47.9-81.3). Overall 90-day mortality was 35.9%. The median LM4 and LM7 for the patients who received treatment was 0.39 (0.19-0.83) and 0.36 (0.13-0.77). LM4 was a strong independent predictor of 28-day mortality (OR 25.4, (95% confidence interval (CI) 5.1-126.8), P<0.001). By using LM4 with a CUV>0.45, 28- and 90-day survival was significantly higher for responders (90% and 76%) than non-responders (66% and 40%), P<0.001. Importantly, the area under the ROC curve for predicting mortality for LM4 was similar than the classic LM7 (0.77 vs. 0.75, respectively: P=0.558).

CONCLUSIONS:

LM4 is as accurate as LM7 in predicting response to corticosteroids, as well as 28- and 90-day mortality. Assessing the efficacy of prednisolone at an earlier time point can avoid a more prolonged futile use of this therapy.

PMID:
27922027
DOI:
10.1038/ajg.2016.539
[Indexed for MEDLINE]

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