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

BARCELONA . SPAIN
56 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 57
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
SIRS was an independent predictor of in-hospital mortality in ACLF. Another independent predictor of shortterm
mortality was ductular bilirubinostasis on biopsy which is an important marker of sepsis and multiorgan
failure (Lefkowitch 1982). Of high importance, ductular bilirubinostasis on histology showed a
clear correlation with development of infection during hospitalization. Taken together the findings of
this study suggest that SIRS and ductular bilirubinostasis, as early signs of infectious complications, might
be helpful to detect ACLF in a stage of the disease when therapeutic interventions might still be effective.
Table 2
A histopathological prognoctic scoring system is currently being validated internationally (Altamirano et al).
Table 1
Multivariate analysis ascertained the following parameters to be related to mortality: age (P= 0.0003),
SIRS within the first 48 hours of admission (P=0.05) and the histological presence of marked ductular
bilirubinostasis (P=0.04) and Mallory bodies (P=0.01). In the CHD group, the small number of death did
not allow us to establish significant differences for in hospital mortality in comparison with the ACLF group
Results
Individual parameters:
Clinical parameters predictive of in-hospital mortality in ACLF within 48 hours of admission and histological
features predictive for mortality at the moment of diagnosis are listed in table 4. Univariate analysis of a
wide spectrum of clinical parameters showed age, INR and SIRS as predictors of in-hospital mortality.
At the moment of diagnosis (around 1 week after admission) serum creatinine (P=0.008) and bilirubin
(P=0.01) levels also predicted outcome. Among histological features marked ductular bilirubinostasis
(P=0.003) (Figure 3) and Mallory bodies (P=0.002) predicted in-hospital mortality.