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Is There a Futility Discriminant Function Score for Alcoholic Hepatitis?

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Steroids may not be futile for severe alcoholic hepatitis (AH). This study found similar 30-day mortality for patients with high discriminant function (DF) scores, whether treated with steroids or not.

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Alcoholic hepatitis (AH) is a severe liver condition often treated with steroids.
  • High discriminant function (DF) scores (>32) indicate severe AH, with prior studies suggesting near 100% mortality for scores >54 despite steroid treatment.

Purpose of the Study:

  • To investigate if a DF score greater than 54 is associated with high 30-day mortality, even with steroid treatment for alcoholic hepatitis.

Main Methods:

  • Retrospective study of 531 first-time inpatient AH encounters.
  • Comparison of 30-day mortality between patients with DF ≤54 and >54 treated with steroids.
  • Matched comparison of patients with DF >54 who received steroids versus those who did not.

Main Results:

  • Among steroid-treated patients, 30-day mortality was 22% for DF >54 vs. 12% for DF ≤54 (p=0.47).
  • For DF >54 patients, 30-day mortality was 22% with steroids vs. 24% without steroids (p=0.87).
  • Steroid treatment did not show futility in patients with DF scores >54 in this study population.

Conclusions:

  • Contrary to previous findings, steroid treatment did not appear futile for alcoholic hepatitis patients with DF scores >54 in this cohort.
  • Further research is warranted to fully understand the role of steroids in severe alcoholic hepatitis based on DF scores.