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

Rakhi Maiwall, Samba Siva Rao Pasupuleti, Ashok Choudhury, Dong Joon kim, Ajit Sood, Omesh Goyal, Vandana Midha, Harshad Devarbhavi, Anil Arora, Ashish Kumar, Manoj Kumar Sahu, Sudhir Maharshi, Ajay Kumar Duseja, Virendra Singh, Sunil Taneja, P. N. Rao, Anand Kulkarni, Hasmik Ghazinian, Saeed Hamid, C. E. EapenAshish Goel, Ananta Shreshtha, Samir Shah, Jinhua Hu, V. G.Mohan Prasad, Nan Yuemin, Xin Shaojie, R. K. Dhiman, Tao Chen, Qin Ning, Charles Panackel, Madunil A. Niriella, Thupten Kelsang Lama, Soek Siam Tan, A. Kadir Dokmeci, Akash Shukla, Manoj Kumar Sharma, Shiv Kumar Sarin

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

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 < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell’s C-index was 0.72 compared to other scores. Conclusion: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.

Original languageEnglish
Pages (from-to)662-675
Number of pages14
JournalHepatology International
Volume17
Issue number3
DOIs
Publication statusPublished - Jun 2023

Keywords

  • A.K.I
  • AARC
  • Ascites
  • Portal hypertension
  • SIRS

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