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News

Scoring system that predicts mortality in alcoholic hepatitis

Using variables associated with mortality, research in the latest Gut issue derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis, that identifies patients at greatest risk of death throughout their admission

News image

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Alcoholic hepatitis is associated with a high short term mortality.

Dr Forrest and colleagues aimed to identify those factors associated with mortality and define a simple score which would predict outcome in the population.

The investigators identified 241 patients with alcoholic hepatitis.

Glasgow alcoholic hepatitis score on day 1 had an accuracy of 81% in predicting 28 day outcome
Gut

The investigative team recorded clinical and laboratory data on the day of admission and on days 6 to 9.

The investigators used stepwise logistic regression was used to identify variables related to outcome at 28 days and 84 days after admission.

These variables were included in the Glasgow alcoholic hepatitis score and its ability to predict outcome assessed, and was validated in a separate dataset of 195 patients.

The team found that the Glasgow alcoholic hepatitis score was derived from 5 variables independently associated with outcome, including age.

Variables independently associated with outcome from day 1 results included serum bilirubin, blood urea and.

The team noted that from day 6 to 9 results, independent outcome variables were serum bilirubin, prothrombin time, and peripheral blood white blood cell count.

The investigators observed that the Glasgow alcoholic hepatitis score on day 1 had an overall accuracy of 81% when predicting 28 day outcome.

In contrast, the modified discriminant function had an overall accuracy of 49%.

The investigators report finding similar results using information at 6 to 9 days and when predicting 84 day outcome.

The team confirmed the accuracy of the Glasgow alcoholic hepatitis score by the validation study of 195 patients.

Glasgow alcoholic hepatitis score was equally accurate irrespective of the use of the international normalised ratio or prothrombin time ratio.

In addition, the team noted that the diagnosis of alcoholic hepatitis biopsy proven or the basis of clinical assessment equally predicted the accuracy of the Glasgow alcoholic hepatitis score.

Dr Forrest's team concludes, “Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis.”

“This score was able to identify patients at greatest risk of death throughout their admission.”

Gut 2005: 54(8): 1174-1179
15 July 2005

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