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Scoring models for short-term mortality in alcoholic hepatitis

April's issue of the Alimentary Pharmacology & Therapeutics evaluates 9 scoring models for short-term mortality in alcoholic hepatitis.

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Several prognostic models have emerged in alcoholic hepatitis, but lack of external validation precludes their universal use.

Professor Burroughs and colleagues from the United Kingdom validated the Maddrey Discriminant Function (DF), Glasgow Alcoholic Hepatitis Score (GAHS), Mayo End-stage Liver Disease (MELD), Age, Bilirubin, INR, Creatinine (ABIC), MELD-Na, UK End-stage Liver Disease (UKELD), and 3 scores of corticosteroid response at 1 week, an Early Change in Bilirubin Levels (ECBL), a 25% fall in bilirubin, and the Lille score.

The researchers evaluated 71 consecutive patients with biopsy-proven alcoholic hepatitis, admitted between 2007 and 2011.

The clinical and biochemical parameters were analysed to assess prognostic models with respect to 30- and 90-day mortality.

Adenomas were detected in 4% with a minimum withdrawal time of 9 minutes
Alimentary Pharmacology & Therapeutics

The team found no significant differences in the areas under the receiver operating characteristics curve (AUROCs) relative to 30-day/90-day mortality.

The area under the receiver operating characteristic curve for MELD was 0.79/0.84, 0.71/0.74 for DF, 0.75/0.78 for GAHS, 0.71/0.78 for ABIC, 0.68/0.76 for MELD-Na, 0.56/0.68 for UKELD.

One-week rescoring yielded a trend towards improved predictive accuracies.

The research team found that in patients with admission DF ≥32, response to corticosteroids according to ECBL, 25% fall in bilirubin and the Lille model yielded AUROCs of 0.73/0.73, 0.78/0.72 and 0.81/0.82 for a 30-day/90-day outcome respectively.

The team observed that all models showed excellent negative predictive values, while the positive ones were low.

Professor Burroughs' team comments, "MELD, DF, GAHS, ABIC and scores of corticosteroid response proved to be valid in an independent cohort of biopsy-proven alcoholic hepatitis."

"MELD modifications incorporating sodium did not confer any prognostic advantage over classical MELD."

"Based on excellent negative predictive values, the models are best to identify patients at low risk of death."

Aliment Pharmacol Ther 2014: 39(7): 721–732
18 March 2014

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