Trajectory Of Serum Bilirubin Predicts Spontaneous Recovery In A Real-World Cohort Of Patients With

In patients with alcoholic hepatitis (AH), researchers wanted to find a reliable method of distinguishing patients who will recover spontaneously in order to minimize patients having to experience side effects of available treatments. Researchers examined the trajectory of serum bilirubin concentration over the course of their stay in 426 patients admitted to the hospital with AH to predict spontaneous survival and the need for treatment. An intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission was presented, as patients were classified into three groups: "fast fallers" (bilirubin <0.8 x admission value at day 7), "static" (bilirubin of >0.9 – <1.2 x admission value) and "rapid risers" (bilirubin of ≥1.2 x admission bilirubin). Compared to other groups "fast fallers" had significantly better 90-day survival, and did not benefit from corticosteroid therapy. This procedure distinguishes a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy, and is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment.

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