Abstract
GOALS: To evaluate the role of the discriminant factor in predicting mortality and deciding on treatment in acute alcoholic hepatitis. BACKGROUND: Current guidelines on the treatment of alcoholic hepatitis restrict the use of corticosteroids to patients with discriminant factor > 32 (severe disease) because of the toxicity of steroids. Less toxic forms of therapy, such as proxyphylline, may have a role in patients with lower discriminant factor, if mortality without therapy is common. STUDY: We performed a 5-year retrospective analysis comparing the outcomes of patients with mild and severe alcoholic hepatitis. Receiver operator characteristic curves were used to study the accuracy of the discriminant factor to predict short-term mortality. RESULTS: Among the 41 patients with severe alcoholic hepatitis (discriminant factor > 32) and 48 with mild alcoholic hepatitis, 16 (39%) and 8 (16.7%), respectively, died within 28 days of admission. Only 11 (32%) actually received corticosteroid therapy. The sensitivity and specificity of the discriminant factor in predicting mortality was 66.7% and 61.5%, respectively. A receiver operator characteristic curve of the discriminant factor gave the optimal value for the discriminant factor as 33, with the area under the curve being 0.666 (P = 0.0078; 95% CI = 0.531-0.801). CONCLUSIONS: Using the value of around 32 maximizes sensitivity and specificity of the discriminant factor in predicting mortality in alcoholic hepatitis. However, there is a high mortality in patients with alcoholic hepatitis and a discriminant factor less than 32. Alternative effective agents should be considered in patients with milder alcoholic hepatitis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 453-459 |
| Number of pages | 7 |
| Journal | Journal of Clinical Gastroenterology |
| Volume | 38 |
| Issue number | 5 |
| State | Published - May 2004 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Gastroenterology
Cite this
The role of the discriminant factor in the assessment and treatment of alcoholic hepatitis. / Kulkarni, Ketan; Tran, Thomas; Medrano, Miles; Yoffe, Boris; Goodgame, Richard.
In: Journal of Clinical Gastroenterology, Vol. 38, No. 5, 05.2004, p. 453-459.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The role of the discriminant factor in the assessment and treatment of alcoholic hepatitis.
AU - Kulkarni, Ketan
AU - Tran, Thomas
AU - Medrano, Miles
AU - Yoffe, Boris
AU - Goodgame, Richard
PY - 2004/5
Y1 - 2004/5
N2 - GOALS: To evaluate the role of the discriminant factor in predicting mortality and deciding on treatment in acute alcoholic hepatitis. BACKGROUND: Current guidelines on the treatment of alcoholic hepatitis restrict the use of corticosteroids to patients with discriminant factor > 32 (severe disease) because of the toxicity of steroids. Less toxic forms of therapy, such as proxyphylline, may have a role in patients with lower discriminant factor, if mortality without therapy is common. STUDY: We performed a 5-year retrospective analysis comparing the outcomes of patients with mild and severe alcoholic hepatitis. Receiver operator characteristic curves were used to study the accuracy of the discriminant factor to predict short-term mortality. RESULTS: Among the 41 patients with severe alcoholic hepatitis (discriminant factor > 32) and 48 with mild alcoholic hepatitis, 16 (39%) and 8 (16.7%), respectively, died within 28 days of admission. Only 11 (32%) actually received corticosteroid therapy. The sensitivity and specificity of the discriminant factor in predicting mortality was 66.7% and 61.5%, respectively. A receiver operator characteristic curve of the discriminant factor gave the optimal value for the discriminant factor as 33, with the area under the curve being 0.666 (P = 0.0078; 95% CI = 0.531-0.801). CONCLUSIONS: Using the value of around 32 maximizes sensitivity and specificity of the discriminant factor in predicting mortality in alcoholic hepatitis. However, there is a high mortality in patients with alcoholic hepatitis and a discriminant factor less than 32. Alternative effective agents should be considered in patients with milder alcoholic hepatitis.
AB - GOALS: To evaluate the role of the discriminant factor in predicting mortality and deciding on treatment in acute alcoholic hepatitis. BACKGROUND: Current guidelines on the treatment of alcoholic hepatitis restrict the use of corticosteroids to patients with discriminant factor > 32 (severe disease) because of the toxicity of steroids. Less toxic forms of therapy, such as proxyphylline, may have a role in patients with lower discriminant factor, if mortality without therapy is common. STUDY: We performed a 5-year retrospective analysis comparing the outcomes of patients with mild and severe alcoholic hepatitis. Receiver operator characteristic curves were used to study the accuracy of the discriminant factor to predict short-term mortality. RESULTS: Among the 41 patients with severe alcoholic hepatitis (discriminant factor > 32) and 48 with mild alcoholic hepatitis, 16 (39%) and 8 (16.7%), respectively, died within 28 days of admission. Only 11 (32%) actually received corticosteroid therapy. The sensitivity and specificity of the discriminant factor in predicting mortality was 66.7% and 61.5%, respectively. A receiver operator characteristic curve of the discriminant factor gave the optimal value for the discriminant factor as 33, with the area under the curve being 0.666 (P = 0.0078; 95% CI = 0.531-0.801). CONCLUSIONS: Using the value of around 32 maximizes sensitivity and specificity of the discriminant factor in predicting mortality in alcoholic hepatitis. However, there is a high mortality in patients with alcoholic hepatitis and a discriminant factor less than 32. Alternative effective agents should be considered in patients with milder alcoholic hepatitis.
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M3 - Article
VL - 38
SP - 453
EP - 459
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
SN - 0192-0790
IS - 5
ER -