The Glasgow alcoholic hepatitis score identifies patients who may benefit from corticosteroids
The Glasgow alcoholic hepatitis score identifies patients who may benefit from corticosteroids
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DOI：
10.1136/gut.2006.099226
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发表时间：
2007-12-01
期刊：
影响因子：
24.5
通讯作者：
Day, C. P.
中科院分区：
文献类型：
--
作者：
Forrest, E. H.;Morris, A. J.;Day, C. P.
前言：酒精性肝炎的药物治疗尚无共识。格拉斯哥酒精性肝炎评分（GAHS）已被证明是更准确的预测酒精性肝炎的结果比改良的马德劳判别函数（MDF）。本研究旨在确定GAHS是否能够确定那些患者谁将受益于corticosteroids.Methods：225例患者的平均膳食纤维大于或等于32从5个医院中心在英国进行了审查。相对于GAHS和使用皮质类固醇的患者生存率recorded.Results：144例患者的一个mDF大于或等于32（64%）也有一个GAHS大于或等于9。对于GAHS小于9的患者，未经治疗或皮质类固醇治疗的患者的生存率没有差异。对于GAHS大于或等于9的患者，未经治疗和皮质类固醇治疗的患者的28天生存率分别为52%和78%。（p = 0.002），84天生存率分别为38%和59%（p = 0.02）。结论：在MDF大于或等于32的患者中，糖皮质激素治疗对GAHS小于9的患者没有明显的益处。GAHS大于或等于9的患者如果不接受皮质类固醇治疗，或如果这种治疗是禁忌的，则预后极差。
Introduction: There is no consensus on the pharmacological treatment of alcoholic hepatitis. The Glasgow alcoholic hepatitis score (GAHS) has been shown to be more accurate than the modified Maddrey's discriminant function (mDF) in the prediction of outcome from alcoholic hepatitis. This study aimed to determine whether the GAHS was able to identify those patients who would benefit from corticosteroids.Methods: 225 patients with an mDF greater than or equal to 32 from five hospital centres in the United Kingdom were reviewed. Patient survival relative to the GAHS and the use of corticosteroids was recorded.Results: 144 patients with an mDF greater than or equal to 32 (64%) also had a GAHS greater than or equal to 9. There was no difference in survival between untreated or corticosteroid-treated patients for those with a GAHS less than 9. For patients with a GAHS greater than or equal to 9 the 28-day survival for untreated and corticosteroid-treated patients was 52% and 78% (p = 0.002), and 84-day survival was 38% and 59% (p = 0.02), respectively.Conclusions: Among patients with an mDF greater than or equal to 32, there was no appreciable benefit from treatment with corticosteroids in patients with a GAHS less than 9. Patients with a GAHS greater than or equal to 9 have an extremely poor prognosis if they are not treated with corticosteroids, or if such treatment is contraindicated.