Model for end-stage liver disease score versus Maddrey discriminant function score in assessing short-term outcome in alcoholic hepatitis.

BACKGROUND AND AIMS: The Maddrey Discriminant Function (mDF) score and the Model for End-Stage Liver Disease (MELD) score are standard prognostic scores for predicting disease severity and mortality in alcoholic hepatitis (AH).This prospective study compared the MELD score and the mDF score as predictors of short-term outcome in AH. METHODS: The admission MELD score and the mDF score were assessed in 47 patients with a diagnosis of AH in the Himalayan Institute Hospital, Dehradun, India and the concordance (C) statistics of the two scores for 28-day mortality were determined and compared. RESULTS: Both the MELD score and the mDF score on day 1 were significantly higher in non-survivors than in survivors (P = 0.0001 each). The C-statistic for 28-day mortality for the MELD score was 0.91 (P < 0.0001, 95% confidence interval [CI] 0.79-0.97) and for the mDF score 0.90 (P < 0.0001, 95% CI 0.78-0.97). There was no significant difference between the C-statistics of the two scores (P = 0.83, 95% CI -0.07 to 0.09). For predicting 28-day mortality, the optimal MELD score of > 19 (sensitivity 91.6% and specificity 85.7%) corresponded to the mDF score of > 52.8 (sensitivity 91.6% and specificity 82.8%). CONCLUSIONS: Both the MELD score and the mDF score at admission were strong and equally good predictors of 28-day mortality in patients with AH, but the optimal mDF score corresponding to optimal MELD score was higher than the conventional one. Thus, MELD score may be used as an alternative to mDF score for predicting short-term mortality in AH with an advantage.

Dengue hepatitis sans dysfunction: experience of a single tertiary referral centre in the north Indian state of Uttarakhand.

Hepatic involvement is uncommon in dengue viral infections and is traditionally thought to be associated with severe disease in terms of morbidity and mortality. This study was conducted in order to assess the liver function in patients with dengue virus infection and to analyse its effect upon patient outcome. Three hundred and twenty-seven consecutive patients with dengue virus were categorized into groups A, B, C and D on the basis of elevation of either of the hepatic transaminases (normal, <3, 3-10 and >10 times, respectively). Primary and secondary outcome measures related to morbidity and mortality were studied. Hepatitis was seen in ∼3/4 patients; an increasing grade of liver involvement was significantly associated with fewer platelets (P < 0.001). Recovery of platelets, bleeding manifestations, renal dysfunction, platelet recovery and duration of hospitalization were similar in all groups. Among the patients with manifest bleeding, the platelet count did not differ significantly but the platelet recovery was significantly slower (P = 0.044) with increasing grade. Hepatic dysfunction is self-limited without any increase in morbidity and mortality.