Prognostic value of early Lille score in patients with severe alcohol-associated hepatitis.

IF 2.2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia Pub Date : 2025-06-20 DOI:10.1016/j.gastrohep.2025.502517

Ana Suárez-Saro Fernández, Mónica Barreales Valbuena, Cristina Martín-Arriscado Arroba, Elena Gómez Domínguez, Álvaro Hidalgo Romero, Inmaculada Fernández Vázquez

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引用次数: 0

Abstract

Objective: To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance compared to the Lille Index on day 7 (LI7).

Patients and methods: This retrospective, observational, single-center study included SAH patients admitted between 2016 and 2023. SAH was defined as a Maddrey score ≥32 and/or a MELD score ≥21. The predictive ability of LI2, LI4, and LI7 for 28-, 90-, and 180-day mortality was analyzed using AUC, Cox regression (Hazar Ratio (HR)), and Kaplan-Meier curves.

Results: Among 65 SAH patients, 62 received corticosteroids. Median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (p>0.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, p=0.752) and LI4 vs. LI7 (73.33% vs. 70.97%, p=0.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7 was 93.33%.

Results: Among 65 SAH patients, 62 received corticosteroids. The median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (p>0.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (p=0.752) and LI4 vs. LI7 (p=0.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7, 93.33%.

Conclusions: LI2 and LI4 were comparable to LI7 in predicting short-term mortality in SAH. Earlier calculation, particularly LI2, could anticipate clinical decisions in poor prognosis patients, such as corticosteroid discontinuation or evaluation for liver transplantation in selected cases.

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早期里尔评分对重度酒精相关性肝炎患者的预后价值。

目的：评价Lille指数（LI）第2天（LI2）和第4天（LI4）预测严重酒精相关性肝炎（SAH）患者短期死亡率的有效性，并与Lille指数第7天（LI7）比较其一致性。患者和方法：这项回顾性、观察性、单中心研究纳入了2016年至2023年住院的SAH患者。SAH定义为Maddrey评分≥32和/或MELD评分≥21。采用AUC、Cox回归（Hazar Ratio， HR）和Kaplan-Meier曲线分析LI2、LI4和LI7对28、90和180天死亡率的预测能力。结果：65例SAH患者中，62例接受糖皮质激素治疗。中位随访时间为722天。LI2与28天死亡率相关，HR为33.1 (95% CI: 3.8-287.3)，与LI7相似(HR: 13.2；95% ci: 2.2-81.2)。LI2的28天死亡率auc为0.818，LI4为0.794，LI7为0.809 （p < 0.05）。LI2与LI7按预后分类的患者比例相似（68.33% vs. 70.97%, p=0.752）， LI4与LI7按预后分类的患者比例相似（73.33% vs. 70.97%, p=0.771）。LI2与LI7的一致性为85%，LI4与LI7的一致性为93.33%。结果：65例SAH患者中，62例接受糖皮质激素治疗。中位随访时间为722天。LI2与28天死亡率相关，HR为33.1 (95% CI: 3.8-287.3)，与LI7相似(HR: 13.2；95% ci: 2.2-81.2)。LI2的28天死亡率auc为0.818，LI4为0.794，LI7为0.809 （p < 0.05）。LI2与LI7、LI4与LI7按预后分类的患者比例相似（p=0.752）。LI2与LI7的一致性为85%，LI4与LI7的一致性为93.33%。结论：LI2和LI4在预测SAH短期死亡率方面与LI7相当。早期计算，特别是LI2，可以预测预后不良患者的临床决策，例如在选定的病例中停用皮质类固醇或评估肝移植。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastroenterologia y hepatologia GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

1.50

自引率

10.50%

发文量

147

审稿时长

48 days

期刊介绍： Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.