Comparison of Maddrey Discriminant Function, Child-Pugh Score and Glasgow Alcoholic Hepatitis Score in predicting 28-day mortality on admission in patients with acute hepatitis.

BACKGROUND: Acute hepatitis (AH) in patients with chronic alcoholic liver disease is associated with high mortality. It is therefore vital to identify patients at greatest risk of mortality who may benefit from aggressive intervention. The scoring systems used to assess the severity of AH [Maddrey Discriminant Function (mDF), Child-Pugh Score (CPS) and Glasgow Alcoholic Hepatitis Score (GAHS)] have shown to be useful in determining severity and predicting mortality in these patients. AIM: The aim of this study was to compare three scoring systems in predicting 28-day mortality in AH on admission. METHOD AND
RESULTS: Case notes of 82 patients with AH were reviewed on admission; mDF, CPS, GAHS were calculated and their outcome recorded on day 28. Thirty-six patients (44%) died within 28 days of admission. There was no difference in the age of patients who survived (51.2 ± 11 years) and those who died (52.6 ± 10 years). However, mDF, CPS and GAHS were significantly higher in dead patients (68.7 ± 56.4, 11.8 ± 1.3, 8.6 ± 1.6, respectively) compared to those who survived (36.2 ± 25.9, 10 ± 1.6, 7.6 ± 1.5, respectively) (p < 0.01). Similarly, prothrombin time (PT) was significantly higher in patients who died (23 ± 2 s) compared to those who survived (17.6 ± 0.7 s) (p = 0.007).
CONCLUSION: There was no difference among three scoring systems in predicting 28-day mortality at the time of admission in patients with AH. In addition, increased PT, gastro-intestinal bleeding and advanced encephalopathy at presentation were associated with high mortality. Furthermore, rise in creatinine from admission increased risk of mortality.