Is There a Futility Discriminant Function Score for Alcoholic Hepatitis?

• Main Authors: Kevin Lamm, Maggie McCarter, Mark W. Russo
• Format: Article
• Language: English
• Published: MDPI AG 2021-06-01
• Series: Journal of Clinical Medicine
• Subjects: alcoholic hepatitis; discriminant function; futility; mortality
• Online Access: https://www.mdpi.com/2077-0383/10/13/2756

The treatment for patients with alcoholic hepatitis (AH) who have a discriminant function (DF) score greater than 32 has been steroids. A prior study reported that mortality approaches 100% when the DF score is greater than 54, despite the use of prednisolone. Our aim was to determine if a DF score greater than 54 is associated with high mortality despite steroids. We conducted a retrospective study of 531 first-time inpatient encounters of AH. We compared 30-day mortality between patients with DF 54 or less to those greater than 54 treated with steroids, as well as a matched group not treated with steroids. A total of 531 inpatients diagnosed with AH were identified, of which 124 had a DF greater than 32 and 52 were treated with steroids. Among patients treated with steroids, 30-day mortality for patients with DF greater than 54 (<i>n</i> = 27) and 54 or below (<i>n</i> = 25) was 22% and 12%, respectively (<i>p</i> = 0.47). Among patients with DF greater than 54, the 30-day mortality for those who did (<i>n</i> = 27) and did not (<i>n</i> = 29) receive steroids was 22% and 24%, respectively (<i>p</i> = 0.87). In our study population, steroids were not futile in patients with a DF score of greater than 54.