A Study to Assess Risk Stratification by Using Child-Pugh Score, Rate of Admission and Management Strategies of Inpatients with Alcoholic Liver Disease

Abstract

Objective: To assess risk stratification using the Child-Pugh scoring system, evaluate hospital admission profiles, and audit real-world pharmacological management in hospitalized patients with Alcoholic Liver Disease (ALD). Methodology: A six-month prospective observational study included 123 confirmed ALD inpatients admitted to the General Medicine Department of ESIC Medical College & Model Hospital, Bengaluru. Demographic characteristics, alcohol consumption history, clinical features, laboratory parameters, and treatment patterns were recorded. Statistical analyses included Chi-square test, one-way ANOVA, Kruskal-Walli’s test, Spearman's rank correlation, and Odds Ratio (OR) analysis. Results: The mean age was 47.30 ± 9.07 years, with 95.12% males. Most patients were classified as Child-Pugh Class C (58.54%), followed by Class B (29.26%) and Class A (12.20%). Alcohol consumption for >10 years was significantly associated with advanced liver disease (p = 0.0096; OR = 2.12). Disease severity was significantly associated with portal hypertension (79.67%, p < 0.001), ascites (65.85%, p < 0.001), hepatic encephalopathy (31.71%, p = 0.00017), hepatorenal syndrome (18.70%, p = 0.0222), coagulopathy (22.76%, p = 0.0216), and esophageal varices (49.60%, p = 0.0437). Laboratory abnormalities, including reduced albumin and elevated bilirubin, INR, AST, ALT, and ALP, correlated with increasing severity (p < 0.01). Although hospital stay did not differ significantly across Child-Pugh classes (p = 0.269), Class C patients had a twofold higher readmission risk (OR = 2.02). Lactulose, rifaximin, ursodeoxycholic acid, furosemide, and spironolactone were the most frequently prescribed drugs, while corticosteroid use was limited (3.25%). Conclusion: The Child-Pugh score is an effective bedside tool for predicting disease severity, complications, and readmission risk in ALD. Variations from evidence-based treatment, particularly excessive ursodeoxycholic acid use and limited corticosteroid prescribing, highlight the need for improved guideline-directed management.