LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis
Introduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has compara...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-02-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268124002527 |
| _version_ | 1797272465369464832 |
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| author | Claudia L. Dorantes-Nava María F. Higuera-de la Tijera Alfredo Servín-Caamaño Gabriela Gutiérrez-Reyes Miguel Y. Carmona-Castillo Sandra Teutli-Carrion Ernesto J. Medina-Avalos José L. Pérez-Hernández |
| author_facet | Claudia L. Dorantes-Nava María F. Higuera-de la Tijera Alfredo Servín-Caamaño Gabriela Gutiérrez-Reyes Miguel Y. Carmona-Castillo Sandra Teutli-Carrion Ernesto J. Medina-Avalos José L. Pérez-Hernández |
| author_sort | Claudia L. Dorantes-Nava |
| collection | DOAJ |
| description | Introduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has comparable accuracy to the Lille model calculated on day 7 (Lille-7). However, this finding has not been validated. Therefore our objective is to determine if Lille-4 is equivalent to Lille-7 in predicting 28-day mortality in patients with probable severe alcoholic hepatitis (AH) as defined by the 2016 consortium criteria sponsored by NIAAA. Materials and Patients: Observational, prospective, ambidirectional, analytical cohort study conducted from January 2010 to April 2023. We collected clinical and biochemical variables upon admission, calculated Lille models, assessed response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, specificity, PPV, NPV, and accuracy of the models were calculated. Results: A total of 327 patients were included, 297 (90.8%) being male. Mean age was 43.4±9.3 years. The 50th percentile for alcohol consumption was 320 g/day (5th-95th percentile: 100.8-662). At day 28, 207 patients (63.3%) died. Upon admission, the patients who died showed a significant difference compared to survivors in: Maddrey (90 [95%CI: 81-99] vs. 70 [95%CI:65-75]; p<0.0001); ABIC (8.8±1.8 vs. 8.1±1.3; p<0.0001); MELD (32±8 vs. 27±4; p<0.0001); MELD-Na (33±6 vs. 30±4; p<0.0001). Lille-7 model had an AUROC of 0.71 [0.65-0.77], where a value >0.45 had a sensitivity (S) of 78% and specificity (E) of 45% in predicting early mortality. Lille-4 model had an AUROC of 0.68 [0.63-0.74], where a value >0.45 had an S of 81% and E of 54% (Figure 1). Conclusions: Lille-7 is the model with the highest accuracy, according to the obtained AUROC, for predicting early mortality in severe alcoholic hepatitis (AH). Therefore, the determination of total bilirubin should not be done prematurely (before day 7), and steroid therapy should be provided to patients for up to 7 days to classify treatment response. |
| first_indexed | 2024-03-07T14:29:45Z |
| format | Article |
| id | doaj.art-1b4790da396a45b4bdc71d3319497b97 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-07T14:29:45Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-1b4790da396a45b4bdc71d3319497b972024-03-06T05:26:16ZengElsevierAnnals of Hepatology1665-26812024-02-0129101458LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitisClaudia L. Dorantes-Nava0María F. Higuera-de la Tijera1Alfredo Servín-Caamaño2Gabriela Gutiérrez-Reyes3Miguel Y. Carmona-Castillo4Sandra Teutli-Carrion5Ernesto J. Medina-Avalos6José L. Pérez-Hernández7Department of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityDepartment of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityDepartment of Internal Medicine, Hospital General de México “Dr. Eduardo Liceaga”, Mexico CityLiver, Pancreas, and Motility Laboratory (HIPAM), Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autonoma de Mexico (UNAM), Mexico CityDepartment of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityDepartment of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityDepartment of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityDepartment of Gastroenterology, Hospital General de Mexico ''Dr. Eduardo Liceaga'', Mexico CityIntroduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has comparable accuracy to the Lille model calculated on day 7 (Lille-7). However, this finding has not been validated. Therefore our objective is to determine if Lille-4 is equivalent to Lille-7 in predicting 28-day mortality in patients with probable severe alcoholic hepatitis (AH) as defined by the 2016 consortium criteria sponsored by NIAAA. Materials and Patients: Observational, prospective, ambidirectional, analytical cohort study conducted from January 2010 to April 2023. We collected clinical and biochemical variables upon admission, calculated Lille models, assessed response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, specificity, PPV, NPV, and accuracy of the models were calculated. Results: A total of 327 patients were included, 297 (90.8%) being male. Mean age was 43.4±9.3 years. The 50th percentile for alcohol consumption was 320 g/day (5th-95th percentile: 100.8-662). At day 28, 207 patients (63.3%) died. Upon admission, the patients who died showed a significant difference compared to survivors in: Maddrey (90 [95%CI: 81-99] vs. 70 [95%CI:65-75]; p<0.0001); ABIC (8.8±1.8 vs. 8.1±1.3; p<0.0001); MELD (32±8 vs. 27±4; p<0.0001); MELD-Na (33±6 vs. 30±4; p<0.0001). Lille-7 model had an AUROC of 0.71 [0.65-0.77], where a value >0.45 had a sensitivity (S) of 78% and specificity (E) of 45% in predicting early mortality. Lille-4 model had an AUROC of 0.68 [0.63-0.74], where a value >0.45 had an S of 81% and E of 54% (Figure 1). Conclusions: Lille-7 is the model with the highest accuracy, according to the obtained AUROC, for predicting early mortality in severe alcoholic hepatitis (AH). Therefore, the determination of total bilirubin should not be done prematurely (before day 7), and steroid therapy should be provided to patients for up to 7 days to classify treatment response.http://www.sciencedirect.com/science/article/pii/S1665268124002527 |
| spellingShingle | Claudia L. Dorantes-Nava María F. Higuera-de la Tijera Alfredo Servín-Caamaño Gabriela Gutiérrez-Reyes Miguel Y. Carmona-Castillo Sandra Teutli-Carrion Ernesto J. Medina-Avalos José L. Pérez-Hernández LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis Annals of Hepatology |
| title | LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis |
| title_full | LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis |
| title_fullStr | LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis |
| title_full_unstemmed | LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis |
| title_short | LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis |
| title_sort | lille 4 vs lille 7 to predict short term mortality in patients with severe alcoholic hepatitis |
| url | http://www.sciencedirect.com/science/article/pii/S1665268124002527 |
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