barcelona . spain - European Association for the Study of the Liver

BARCELONA . SPAIN
100 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 101
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
(GAHS) has been validated in the UK. Among patients with a DF ≥ 32 and a GAHS ≥ 9 prognosis was
extremely poor if they were not treated with corticosteroids. The ABIC score identifies patients with a 90 day
and 1 year survival rate of respectively 100%, 70% and 25% (21). The authors retrospectively evaluated
the response to corticosteroids and found that this was 100%, 71% and 33% in the patients with low,
intermediate and high risk of death respectively. For the MELD, there is uncertainly about the threshold for
initiating corticosteroids. Finally one score allow to discriminate the respons rate to corticosteroids during
treatment: a Lille score at day 7 of ≤ 0.16 discriminated the best responders (19).
Table 1: Prognostic scores used for patients with alcoholic hepatitis
Infection is commonly seen in patients with severe ASH and is found in around 25% of the patients. Recent
data demonstrated that after control of the infection corticosteroids are not contraindicated for the treatment
of ASH. Infection during steroid treatment however was the explanation of non-respons to corticosteroids
in agreement of the concept of the ACLF (22).
c.The value of liver biopsy in patients with ASH.
Although liver biopsy is not required to establish the diagnosis of ASH and a well validated histological
classification is still lacking, biopsy can be helpful. Indeed as already mentioned not every sudden
exacerbation of alcoholic cirrhosis is due to severe ASH (2). Biopsy will not only allow a correct diagnosis
of ASH, it is helpfull to define the severity of ASH and the presence of liver polymorphonucclear infiltrate
has prognostic value (23). Biopsy can also recognize the patients in a pre-cirrotic stage which might have
a better outcome. Finally, biopsy can also help to diagnose sepsis in an early stage which is useful to
recognize ACLF (24).
CONCLUSIONS
Several precipitating events can provoke ACLF in patients with alcoholic liver disease. One of the frequent
triggers is severe ASH. Early and aggressive control of these precipitating events can reverse ACLF. In
patients with ASH and bad prognoses corticosteroids prevents ACLF.
Several disease specific prognostic scores are available for patients with ASH. Some of them are helpful
to select the best candidates for corticosteroid and one score (Lille) can select non-responders early during
treatment.
Figure 1
Different outcome of patients with chronic liver failure due to chronic hepatitis decompensation (CHD) or
acute-on-chronic liver failure (ACLF) due to alcohol (Katoonizadeh et al GUT 2010).
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