John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Prognostic scores in hepatology: non specific scores of cirrhosis, alcoholic hepatitis and ICU specific scores Volume 22, issue 4, Avril 2015


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1 CHRU de Lille,
Hôpital Claude Huriez,
services des maladies de l’appareil digestif,
59037 Lille cedex,
2 Unité INSERM U995,
Université de Lille,
* Tirés à part

Morbidity and mortality due to liver cirrhosis remain high. The prognostic evaluation of this disease and its complications helps to guide patients to liver transplantation, to establish specific treatment of alcoholic hepatitis, to allow admission of patients in intensive care unit and to discuss pursuit of care. Child-Pugh score and Model of End-stage Liver Disease (MELD) score are the most used scores, with a good prognostic value in the short, medium and long term. MELD score best predicts short-term mortality risk of chronic liver disease populations and has been adopted in different national organ allocation system for liver transplant candidates. Adding variables evaluating the severity of portal hypertension and malnutrition in new scores may improve the prediction. These new scores are not yet used in routine practice. Maddrey score defines short term mortality of acute alcoholic hepatitis : a score ≥ 32 is associated with a mortality of 40% justifying steroids therapy. Lille score is a dynamic evaluation and the only one to assess steroid treatment response in alcoholic hepatitis including bilirubin difference between the 1st and 7th day of corticosteroid treatment and distinguish two populations at high (non-responders) and low risk (responders) of short term death. Cirrhotic patients are increasingly admitted to intensive care unit. Specific ICU scores such as SOFA and SAPS2 show the best prognostic performance compared to generic scores of cirrhosis. Calculation of ICU scores on the 3rd day should be used to discuss the pursuit or limitation of care. This review will discuss mortality scores available for liver cirrhosis and alcoholic hepatitis evaluation, highlighting the most useful in clinical practice.