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Master Thesis

Évaluation de la gravité des pathologies hépatiques liées à l'alcool : étude rétrospective aux urgences adultes du CHU de Clermont-Ferrand

Abstract : Backgroung : Alcohol remains the main cause of chronic liver disease which has a natural history marked by periods of acute decompensation. One specific type of acute decompensation, Acute-on-Chronic Liver Failure (ACLF), has recently been described ; it is associated with one or multi-organ failure and carries a high mortality. Methodology : A retrospective observational study was conducted at the emergency department of the Gabriel Montpied “Centre Hospitalier Universitaire” (CHU – University Hospital), from January to December 2017. Patients with alcoholic liver disease were selected. MELD, MELD Na, and Child Pugh scores were calculated and compared with new scores developed by the European Association for the Study of the Liver-chronic liver failure (EASL-CLIF Consortium). Standard demographic and clinical data were also collected. Results : 183 patients were included. The average age of the sample was 63 years with 69% being male. Both the standard scores and the ones developed by the EASL-CLIF Consortium showed a higher severity of disease in cirrhotic patients. 22 % of selected patients died within one year, including 6 at the emergency unit. The CLIF C OF showed that 125 patients did not present an ACLF (level 0) while 33 did (level ≥ 1) Even though the CLIF C ACLF recommended that 37% of patients were transferred to the Intensive Care Unit (ICU), only 8% had effectively been transferred. Among the 125 level 0-ACLF patients, the estimate of the CLIF C AD score concluded in the recommendation to transfer 20% of patients to the ICU ; in reality, only 6% were transferred. Conclusion : The new scores developed by the EASL-CLIF Consortium are better adapted than the former standard scores to assess the level of severity of patients with alcoholic liver disease at the emergency unit. There is a high probability for these patients’ health to significantly deteriorate and they should benefit from ICU care as soon as they are admitted at the emergency unit. The necessity for these patients to be treated at the ICU seems to be under-valued within the Gabriel Montpied hospital.
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Submitted on : Monday, February 18, 2019 - 3:11:56 PM
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Louise Puret. Évaluation de la gravité des pathologies hépatiques liées à l'alcool : étude rétrospective aux urgences adultes du CHU de Clermont-Ferrand. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02023406⟩



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