AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study

Maiwall R 1 , Pasupuleti SSR 2 , Choudhury A 1 , Kim DJ 3 , Sood A 4 , Goyal O 4 Show all authors , Midha V 4 , Devarbhavi H 5 , Arora A 6 , Kumar A 6 , Sahu MK 7 , Maharshi S 8 , Duseja AK 9 , Singh V 9 , Taneja S 9 , Rao PN 10 , Kulkarni A 10 , Ghazinian H 11 , Hamid S 12 , Eapen CE 13 , Goel A 13 , Shreshtha A 14 , Shah S 15 , Hu J 16 , Prasad VGM 17 , Yuemin N 18 , Shaojie X 19 , Dhiman RK 20 , Chen T 21 , Ning Q 22 , Panackel C 23 , Niriella MA 24 , Lama TK 25 , Tan SS 26 , Dokmeci AK 27 , Shukla A 28 , Sharma MK 1 , Sarin SK 29

Affiliations 

  • 1 Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
  • 2 Department of Statistics, Mizoram University (A Central University), Pachhunga University College Campus, Aizawl, India
  • 3 Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
  • 4 Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
  • 5 Department of Hepatology, St Johns Medical College, Bangalore, India
  • 6 Department of Gastroenterology, Sir Ganga Ram Hospital and GRIPMER, Delhi, India
  • 7 Department of Hepatology, IMS & SUM Hospital, Bhubaneshwar, Odisha, India
  • 8 Department of Gastroenterology, SMS Medical College, Jaipur, India
  • 9 Department of Hepatology, PGIMER, Chandigarh, India
  • 10 Asian Institute of Gastroenterology, Hyderabad, India
  • 11 Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
  • 12 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 13 Department of Hepatology, Christan Medical College, Vellore, India
  • 14 Alka Hospital, Lalitpur, Nepal
  • 15 Department of Hepatology, Global Hospital, Mumbai, India
  • 16 Department of Medicine, Military Hospital, 302, Beijing, China
  • 17 Department of Gastroenterology, VGM Hospital, Coimbatore, India
  • 18 Hebei Medical University, Shijiazhuang, China
  • 19 The Medical School of Chinese PLA, Beijing, China
  • 20 SGPGI, Lucknow, India
  • 21 Tongji Hospital, Wuhan, China
  • 22 Department of Medicine, Tongji Hospital, Tongji Medical College, Wuhan, China
  • 23 Aster Medicity, Kochi, India
  • 24 Department of Medicine, University of Kelaniya, Ragama, Sri Lanka
  • 25 Civil Service Hospital, Kathmandu, Nepal
  • 26 Selayang Hospital, University of Malaysia, Selangor, Malaysia
  • 27 Department of Medicine, Ankara University School of Medicine, Ankara, Turkey
  • 28 Seth GS Medical College and KEM Hospital, Mumbai, India
  • 29 Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India. shivsarin@gmail.com
Hepatol Int, 2023 Jun;17(3):662-675.
PMID: 36571711 DOI: 10.1007/s12072-022-10463-z

Abstract

BACKGROUND AND AIM: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients.

METHODS: Prospectively collected data from the AARC database were analyzed.

RESULTS: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild-moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille's model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12-0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14-0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63-4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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