Current prognostic scoring systems in assessment of short term mortality
Journal Title: International Journal of Medical Science and Diagnosis Research (IJMSDR) - Year 2017, Vol 1, Issue 1
Abstract
Aim & Objectives: To study clinical profile and compare utility of various prognostic scoring systems in predicting 30-day mortality in patients with severe Alcoholic hepatitis(AH).Compare various parameters currently used for assessment of response to steroid therapy at day7. Patients and Methods: This is a prospective comparative study and was approved by ethics committee of the hospital. Patients 18 years or older with clinical alcoholic hepatitis, aspartate amino transferase (AST)/alanine amino transferase (ALT) ratio >2 with an AST level <500 U/L and MDF ≥ 32 were included in the study. Patients were assessed at admission for severity of liver disease, presence of complications, infections. MELD, CTP, DF, ABIC, GAHS, UKELD, Na-MELD scores were calculated on admission while MELD, MDF, CTP, Lille score, early change in bilirubin levels(ECBL), increase in creatinine were documented at 7days in patients who received therapy. The area under receiver operating curves (AUROCs) for all the scores at the time of admission and on day7 were calculated and compared for 30-day mortality. Results: The 30day mortality of severe AH in the current study was 40%. Hepato renal syndrome(HRS), liver function tests(LFTs), Prothrombin time(PT), urea and creatinine and all scores including CTP, MELD, MDF,GAHS, ABIC, sodium-MELD and UKELD showed significant association with 30day mortality on univariate analysis while UKELD and CTP showed most significance on multivariate analysis. The area under receiving operating curves(AUROCs) for the prediction of 30-day mortality ranged from 1.00 for MELD, 0.997 for MDF, 0.933 for both UKELD and ABIC. At higher than current cut-off values, the specificity and positive predictive value (PPV) of the scores was significantly increased with most scores having >90% specificity for 30 day mortality while sensitivity and the AUROCs of all scores was also increased, ranging from AUROC of 0.933 for UKELD at a value of 65.6 to an AUROC of 1.00 for a MELD score of 25.9. Conclusion: All evaluated scores at time of admission showed good sensitivity and specificity for assessment of 30-day mortality risk in patients with severe alcoholic hepatitis. UKELD, CTP score and HRS showed most significance on multivariate cox-regression analysis for 30-day mortality. At higher cut-off values, MDF, MELD, UKELD can be used to stratify risk and identify patients with very high 30-day mortality.
Authors and Affiliations
Dr S Geet
Keywords
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