P13 Predictors of survival in severe alcoholic hepatitis patients treated with low volume centrifugal plasma exchange and low dose steroid

<h3>Background</h3> Severe alcoholic hepatitis (SAH) patients have high short-term mortality (1). Plasma exchange has improved survival among SAH patients (2). The predictors of response to plasma exchange (PLEX) must be studied. <h3>Methods</h3> In a prospective PLEX database, we analysed the data of SAH patients. NIAAA criteria was used for SAH definition and EASL-CLIF definition was used for Acute on chronic liver failure (ACLF) (3 4). Low volume (0.5 times plasma volume per session) centrifugal PLEX (cPLEX) with low dose steroid (T. Prednisolone 10 mg/ 20 mg once daily) was the protocol used (5). We excluded patients with advanced ACLF (ACLF grade 3). Delta bilirubin [(baseline bilirubin- bilirubin after third PLEX)*100/baseline bilirubin] was studied as dynamic parameter. Modified Lille’s score (MLS) was calculated using the baseline and bilirubin value after third PLEX. This study was approved by the institutional review board and ethics committee. <h3>Results</h3> Over a 6-year period (2017–2023), there were 72 patients (all males) aged 42.4 (±8.5) years, with MELD score 29.8 (±5.7) and CLIF OF score (COS) 10 (±1). 26 patients had no ACLF, 13 patients had grade1 ACLF and 33 patients grade 2 ACLF. Overall transplant-free survival estimates were; 82% (4.6) at 1 month, 49.3% (5.9) at 3 months and 38% (5.8) at 1 year. On univariate Cox regression, baseline INR, DF score, MELD score, COS, delta bilirubin and MLS were predictors of outcome at 1 year. Baseline INR value of ≤2.7 and delta decline in bilirubin &gt;36% predicted favorable outcome. Patients were grouped into 4 based on the above two factors: Group A (n-23): delta decline in bilirubin &gt;36% and INR ≤2.7, Group B (n-7): delta decline in bilirubin &gt;36% and INR &gt;2.7, Group C (n-30): delta decline in bilirubin ≤36% and INR ≤2.7 and Group D (n-12): delta decline in bilirubin ≤36% and INR &gt;2.7. Survival estimates for patients in the above groups at 90 days were as follows: Group A 82.6%, Group B 28.5%, Group C 40% and Group D 9%. Survival estimates for patients in the above groups at 1 year were as follows: Group A 74%, Group B 0%, Group C 29.2% and Group D 9%. Figure 1 shows the Kaplan Meier survival curve of the four groups. <h3>Conclusion</h3> Outcome of SAH patients (excluding ACLF grade 3) treated with cPLEX and low dose steroid can be predicted using baseline INR and delta decline in bilirubin after third PLEX. <h3>References</h3> Carithers RL, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, et al. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med. 1989 May 1;110(9):685–90. Kumar SE, Goel A, Zachariah U, Nair SC, David VG, Varughese S, et al. Low Volume Plasma Exchange and Low Dose Steroid Improve Survival in Patients With Alcohol-Related Acute on Chronic Liver Failure and Severe Alcoholic Hepatitis - Preliminary Experience. J Clin Exp Hepatol. 2022;12(2):372–8. Crabb DW, Bataller R, Chalasani NP, Kamath PS, Lucey M, Mathurin P, et al. Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016 Apr 1;150(4):785–90. Moreau R, Tonon M, Krag A, Angeli P, Berenguer M, Berzigotti A, et al. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. Journal of Hepatology. 2023 Aug 1;79(2):461–91. Goel A, Zachariah U, Daniel D, Eapen CE. Growing Evidence for Survival Benefit with Plasma Exchange to Treat Liver Failure. J Clin Exp Hepatol. 2023;13(6):1061–73.