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Prognostic value of early Lille score in patients with severe alcohol-associated hepatitis
Ana Suárez-Saro Fernández1, Mónica Barreales Valbuena1, Cristina Martín-Arriscado Arroba2
1Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España.
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>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, P=.752) and LI4 vs. LI7 (73.33% vs. 70.97%, P=.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>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (P=.752) and LI4 vs. LI7 (P=.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.
