P4 CLIF-C ACLF score is the optimal predictor of mortality for patients with alcohol-related hepatitis admitted to a specialist intensive care unit

<h3>Introduction</h3> Alcohol-related hepatitis (AH) is a life-threatening syndrome often resulting in extrahepatic organ failures requiring intensive care unit (ICU) admission. In carefully selected cases, liver transplantation (LT) may serve as a life-saving treatment. However, LT is not available for such patients in the UK. We aimed to characterise outcomes of patients with AH admitted to a UK ICU and determine the proportion of patients that would have been evaluated for LT in other allocation policies. <h3>Methods</h3> We retrospectively identified patients admitted to a single specialist liver ICU with AH between 2018 and 2022. A compatible liver biopsy result or fulfilment of the National Institute on Alcohol Abuse and Alcoholism criteria were used to define AH. We collected physiological and addiction profile data and performed logistic regression analyses to identify factors associated with the primary endpoint (90-day survival). <h3>Results</h3> 62 patients (41 (66%) male) were included, with a median age of 44 years (IQR 36–53). No patient underwent LT. The median number of organ failures on admission to ICU was 4 (IQR 3–5). The median Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score on admission was 63 (57–69). 37 (60%) patients were treated with steroids (median duration 8 days (7–16)), of which 17 (46%) responded according to the Lille model. Steroid responsiveness was not associated with survival (p = 0.38). 90-day survival rate was 46%. On multivariate analysis adjusting for age and gender, MELD, CLIF-C ACLF, Glasgow Alcoholic Hepatitis, and Lille scores on day 7 were associated with 90-day outcome. CLIF-C ACLF scores had the highest performance with area under the curve of 0.81 (95%CI 0.66–0.90) on day 1 of ICU admission, 0.88 (0.75–0.94) on day 3 and 0.93 (0.83–0.97) on day 7. Of the 32 non-survivors at 90 days, there were 3 (9%) patients, of median age 47 years, who met the following criteria: no history of decompensation or previous AH, good family support, low clinical frailty score, no co-addictions and no major co-morbidities. <h3>Discussion</h3> Patients with AH admitted to ICU have a high 90-day mortality. We identified day 7 CLIF-C ACLF score as the best predictor of 90-day survival. 3 (9%) non-survivors at 90 days could have potentially fulfilled stringent criteria regarding selection for LT. Research efforts should focus on non-LT based therapies in this high mortality group.