A Lille model for predicting the response of severe alcoholic hepatitis to corticosteroid treatment in Japanese patients
A Lille model for predicting the response of severe alcoholic hepatitis to corticosteroid treatment in Japanese patients
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DOI：
10.1111/hepr.13334
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发表时间：
2019-07-01
影响因子：
4.2
通讯作者：
Takikawa, Yasuhiro
中科院分区：
文献类型：
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作者：
Suzuki, Yuji;Kakisaka, Keisuke;Takikawa, Yasuhiro
目的糖皮质激素是治疗重度酒精性肝炎（SAH）最广泛使用的药物。皮质类固醇的治疗效果由里尔模型评估，该模型已在北美和欧洲的患者队列中得到很好的验证；然而，其有效性尚未在日本患者中得到独立证实。本研究旨在确定Lille模型是否可以预测日本SAH患者的预后。方法回顾性队列研究，纳入我院2011年4月至2018年2月收治的32例SAH患者。根据先前验证的里尔模型临界值，将接受皮质类固醇治疗的患者分为皮质类固醇反应者和无反应者（反应者获得里尔评分>= 0.45），然后评估6个月的预后。结果32例患者中26例接受糖皮质激素治疗。皮质类固醇治疗组28天和6个月的死亡率分别为23.1%和46.2%。死亡或行肝移植患者的中位Lille评分（0.647）显著高于未行肝移植存活患者（0.226;P < 0.0182）。无应答者（Lille评分>= 0.45）的6个月无移植生存率（27.3%，95%可信区间为9.0 ~ 58.6%）显著低于应答者（Lille评分< 0.45,73.3%，95%可信区间为46.7 ~ 90.0%,P = 0.0149， log-rank检验）。结论Lille评分可用于预测日本SAH患者皮质类固醇治疗后6个月的预后。
Aim Corticosteroids are the most widely used agents for the treatment of severe alcoholic hepatitis (SAH). The therapeutic effectiveness of corticosteroids is assessed by the Lille model, which has been validated well in patient cohorts in North America and Europe; however, its usefulness has not yet been confirmed independently in Japanese patients. The present study aimed to determine whether the Lille model could predict the prognosis of SAH in Japanese patients. Methods This was a retrospective cohort study including 32 SAH patients who were admitted to our institute from April 2011 to February 2018. According to the previously validated Lille model cut-off value, patients who received corticosteroids were classified as corticosteroid responders or non-responders (with responders obtaining a Lille score >= 0.45), followed by assessment for the 6-month prognosis. Results Out of 32 patients, 26 were treated with corticosteroids. The 28-day and 6-month mortality rates in the corticosteroid-treated group were 23.1% and 46.2%, respectively. The median Lille score was significantly higher in patients who died or underwent liver transplantation (0.647) than in those who survived without undergoing transplantation (0.226; P < 0.0182). The 6-month transplant-free survival rate of non-responders (Lille score >= 0.45) was significantly lower (27.3%; 95% confidence interval, 9.0-58.6%) than that of responders (Lille score < 0.45, 73.3%; 95% confidence interval, 46.7-90.0%; P = 0.0149, log-rank test). Conclusions The Lille score could be useful for predicting the 6-month prognosis of Japanese SAH patients after corticosteroid therapy.