P- 32 VALIDATION OF LILLE-4 VERSUS LILLE-7 TO PREDICT SHORT-TERM MORTALITY IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS

Introduction and Objectives

It has been proposed to calculate the Lille score on day 4 (Lille-4), which supposedly has comparable accuracy to the Lille score calculated on day 7 (Lille-7) for alcoholic hepatitis (AH). However, this finding has not been validated. This study aimed to validate the use of Lille-4 in predicting response to steroid treatment in patients with severe AH in the Mexican population, with the aim of reducing the risk of secondary complications associated with their use.

Materials and Methods

Observational, prospective, ambilective, analytical, cohort study from January 2010 to April 2023. Clinical and biochemical variables were collected upon admission, and Lille models were calculated to evaluate response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, PPV, NPV and accuracy of the models were calculated.

Results

A total of 327 patients were included, 297 (90.8%) men. The mean age was 43.4±9.3 years, and 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, 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±1.8vs.8.1±1.3; p<0.0001), MELD(32±8vs.27±4;p<0.0001), and MELD-Na(33±6vs.30±4;p<0.0001). The AUROC for Lille-7 was 0.71[0.65-0.77], where a value >0.45 had a sensitivity (S) of 78% and specificity (E) of 45% for predicting early mortality. Lille-4 had an AUROC of 0.68[0.63-0.74], where a value >0.45 had an S=81% and E=54% (Figure 1).

Conclusions

Lille-7 showed higher accuracy, in predicting early mortality in severe AH. Therefore, the determination of total bilirubin should not be before day 7, and steroid therapy should be provided to patients for up to 7 days to classify treatment response.