Comparison of Model for End-stage Liver Disease Score with Discriminant Function and Child-Turcotte-Pugh Scores for Predicting Short-term Mortality in Korean Patients with Alcoholic Hepatitis

Jeong, Jae Yoon; Sohn, Joo Hyun; Son, Byoung Kwan; Paik, Chang Hee; Kim, Seok Hwan; Han, Dong Soo; Jeon, Yong Chul; Lee, Min Ho; Lee, Dong Hoo; Kee, Choon Suk

Abstract

BACKGROUND/AIMS
Alcoholic hepatitis is an acute or acute-on-chronic inflammatory syndrome associated with significant morbidity and mortality. Traditionally, Maddrey discriminant function (DF) score and Child-Turcott- Pugh (CTP) score have been used for stratifying the prognosis of alcoholic hepatitis. Recently, the model for end-stage liver disease (MELD) score has been applied to alcoholic hepatitis and some investigators consider MELD score as a better prognostic indicator for severe alcoholic hepatitis. Therefore, this analysis was aimed to compare MELD score with DF and CTP scores for predicting the short-term mortality in Korean patients with alcoholic hepatitis.
METHODS
The medical records of patients hospitalized with alcoholic hepatitis between January 1, 1999 and December 31, 2004 at Hanyang University Guri-Hospital were analyzed retrospectively.
RESULTS
Of the 138 medical records reviewed, 74 cases fulfilled the inclusion criteria (61 males and 13 females; mean age 47.1 years). Twelve patients (16.2%) died within 90 days after admission. Univariate analysis demonstrated that variables such as ascites, hepatic encephalopathy, splenomegaly, international normalized ratio, CTP, and DF scores were significantly correlated with increased 90-day mortality while MELD score was not. According to the multivariate analysis, only CTP score was statistically significant (p=0.012) while DF and MELD scores were not significant for predicting 90-day mortality. The survival analysis with Cox regression test showed higher DF and CTP scores, but not MELD score, significantly increased the risk of in-hospital mortality.
CONCLUSIONS
This study demonstrates that DF and CTP scores are independent predictors of short-term mortality in patients with alcoholic hepatitis.