Prognosis And Infection Assessment Of Severe Alcoholic Hepatitis

Background: Severe alcoholic hepatitis(SAH)usually occurs based on alcoholic hepatitis or alcoholic cirrhosis,and it may appear liver failure or decompensation,with many complications and high short-term mortality.We evaluated the clinical characteristics of SAH with different underlying liver diseases and compared the available predictive scores.We assessed the predictive value of blood neutrophil/lymphocyte ratio(NLR)for infection in patients with alcoholic cirrhosis complicated SAH.We constructed a baseline and 7-day nomogram prediction model to provide individualized prognosis evaluation for SAH patients complicated ACLF,and provide a basis for the timing of liver transplantation intervention.Methods:(1)We divided the patients with SAH into group A(patients with underlying noncirrhotic chronic liver disease),group B(patients with previously compensated cirrhosis),and group C(patients with previous decompensated cirrhosis).The clinical characteristics,complications,and 28-day mortality of the patients were analyzed.Three groups of survival curves were drawn by the Kaplan-Meier method,and the difference in survival rate was compared by the Long-rank test.Logistic regression analysis was used to screen the risk factors related to 28-day mortality.The ROC was used to compare the short-term prognosis of patients with different prognosis scores.(2)The patients with alcoholic cirrhosis complicated SAH were divided into infected group and non-infected group.The indexes in the two groups were compared,and the relationship between NLR and infection was clarified by the generalized additive model.If the curve fitting result between the two groups was non-linear,we analyzed the threshold effect by the piecewise regression model.(3)Baseline nomogram and 7-day nomogram models were constructed to evaluate a 90-day prognosis.We used ROC,C index,and calibration curve to assess the performance of the model.Results:(1)27 patients in group A,52 patients in group B,and 91 patients in group C.The incidence of infection was 8 / 27(29.6%)in group A,22 / 53(42.3%)in group B,56 / 91(61.5%)in group C,and higher than that in group A(P = 0.011).The survival rates of group A,group B,and group C were 88.9%,80.8%,and 51.6%,respectively.There was a significant difference among the three groups(P < 0.001).The ROC curve analysis showed that the MELD score,MDF score,GAHS score,ABIC score,and CLIF-SOFA score were 0.584,0.696,0.644,0.745,and 0.795,respectively.There were significant differences between CLIF-SOFA and MDF,MELD,and GASH(P < 0.05).The best threshold of CLIF-SOFA score for predicting 28-day mortality was 8.5,with a sensitivity of 79.0% and a specificity of 67.9%.The basis of underlying liver disease(P = 0.0267)was an independent risk factor for a 28-day prognosis.(2)The clinical data of 143 patients with alcoholic cirrhosis complicated SAH were collected.According to the presence or absence of infection,we divided the patients into the non-infected group(n = 69)and the infected group(n = 74).When NLR < 13.37,the risk of infection increased by 15% for each 1.00 increase in NLR,OR = 1.15,95% CI(1.04,1.27),P = 0.0065.(3)The clinical data of 96 patients with SAH complicated ACLF were collected.There were 15 patients with ACLF-1,66 patients with ACLF-2,and 15 patients with ACLF-3.The number of deaths within 90 days was 66(68.8%).Organ failure,ascites grade,and hepatic encephalopathy grade on the 7th day after admission were all more serious than those on admission.The area of ROC predicted by baseline nomogram was 0.818,C index was 0.728,the area of ROC on the 7th day after admission was 0.904,C index was 0.756,there was a statistical difference between the two(P = 0.0468).Conclusions:(1)The clinical characteristics and short-term prognosis of SAH with different underlying liver diseases were different.Chronic underlying liver diseases were independent risk factors for the 28-day prognosis of SAH patients.This study also showed that the CLIF-SOFA scoring system could predict the prognosis of SAH patients at 28-day.(2)NLR was positively correlated with the risk of infection in a certain range.NLR was an indicator to predict infection in patients with alcoholic cirrhosis complicated SAH.(3)The baseline nomogram and the 7-day nomogram may predict the 90-day prognosis of SAH patients complicated ACLF,while the 7-day nomogram prediction model was better than the baseline.