A Clinical Study of Spectrum of Liver Diseases in Alcoholic with Respect to Predictors of Severity and Prognosis

Abstract

Alcoholic liver disease (ALD) is the second most common cause of mortality in humans every year occurring due to overconsumption of alcohol. The spectrum of ALD includes fatty liver/steatosis, alcoholic hepatitis, steatohepatitis, chronic hepatitis with liver fibrosis or cirrhosis, and hepatocellular carcinoma. The diagnosis of ALD can generally be made based on clinical and laboratory features alone in patients with a history of significant alcohol consumption. Prognostic scores such as Child-Pugh classification, MELD, MELD-Na, and Maddrey’s discriminant function (MDF) are used commonly to predict mortality in patients with ALD.The aim of the study is to evaluate the spectrum of liver diseases in alcoholic patients and factors predicting severity and prognosis in such patients. This was a prospective, longitudinal and observational study conducted on 83 patients with ALD admitted in medicine inpatient department from January 2019 to December 2020. Demographic data, biochemical parameters, and clinical features of the patients were evaluated. From the data obtained prognostic scores of Child-Pugh classification, MELD, MELD-Na, and MDF were calculated. Patients were clinically evaluated and all the biochemical parameters and scores were assessed on admission and after the 7th and 30th days. The majority of the patients were males (95.18%) with a mean age of 49.44 ± 7.67. The mean duration of hospital stay of the patients was 34.33 ± 12.98 and approximately 76% of the patients were still consuming alcohol at the time of hospitalisation. Jaundice and ascites were present in all 83 patients, and loss of appetite (85.5%) and nausea and vomiting (78.3%) were the most common clinical features. Complications such as hepatic encephalopathy (85.5%) and oesophageal varices (80.72%) were common on admission. MELD and MELD-Na score > 24 was found in 59 patients and discriminant function (DF) score was more than 32 in 81 patients. Mortality analysis showed that 6 (7.2%) patients died within 1 week of admission and MELD was found to be the best predictor of mortality compared to CTP, MELD-Na, and DF by 7 days. Thirty-two (38.5%) patients died within 30 days of admission. MELD-Na was found to be the best predictor of mortality compared to CTP, MELD, and DF by 30 days. The presence of ascites, hepatic encephalopathy, high bilirubin, low albumin, high creatinine, high INR, and low sodium is found to be independent predictors of mortality. MELD and MELD-Na are good predictors of mortality over the short-term (7–30 days).