Trajectory of Serum Bilirubin Predicts Spontaneous Recovery in a Real-World Cohort of Patients with Alcoholic Hepatitis

Abstract Background and aims Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments. Methods We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment. Results data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: ‘fast fallers’ (bilirubin 0.9 – Conclusions We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy.