D Morales-Arráez1,2, M Ventura-Cots1, J Altamirano3, J G Abraldes4, M Cruz-Lemini5, M R Thursz6, S R Atkinson1,6, S K Sarin7, W Kim8, R Chavez-Araujo9, M F Higuera-de la Tijera10, A K Singal11, V H Shah12, P S Kamath12, A Duarte-Rojo13, E A Charles1, V Vargas14, M Jager15, P E Rautou15,16, D Rincon17, F Zamarripa18, J C Restrepo-Gutiérrez19, A Torre20, M R Lucey21, J P Arab22, P Mathurin23,24, A Louvet23, G García-Tsao25, J A González26, E C Verna27, R S Brown28, J Argemi1,29, C Fernández-Carrillo1, A Clemente1,30,31, E Alvarado-Tapias1, E Forrest32, M Allison33, R Bataller1. 1. Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA. 2. Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Canarias, Spain. 3. Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain. 4. Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada. 5. Women and Perinatal Research Group, Obstetrics and Gynecology Department, Sant Pau University Hospital, Barcelona, Spain, and Maternal and Child Health and Development Network (SAMID, RD16/0022/0015), Instituto de Salud Carlos III, Spanish Ministry of Health, Spain. 6. Department of Metabolism, Digestive disease and Reproduction, Imperial College London, UK. 7. Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India. 8. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. 9. Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. 10. Servicio de Gastroenterología, Hospital General de México, México. 11. Division of Gastroenterology and Hepatology, the University of Alabama at Birmingham, Birmingham, Alabama, USA. 12. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 13. Division of Gastroenterology and Hepatology, Department of Medicine, the University of Arkansas for Medical Science, Little Rock, Arkansas, USA. 14. Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, CIBERehd, Barcelona, Spain. 15. Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France. 16. Inserm, UMR-970, Paris Cardiovascular Research Center, PARCC, Paris, France. 17. Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and Universidad Complutense, Madrid, Spain. 18. Gastroenterology, Juarez Hospital, Mexico City, Mexico. 19. Liver Transplant Program, Hospital Pablo Tobon Uribe, University of Antioquia, Medellin, Colombia. 20. Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. 21. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 22. Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 23. Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France. 24. LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France. 25. Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, Connecticut¸ USA. 26. Gastroenterology Department, Hospital Universitario "Dr. José E González" Universidad Autónoma de Nuevo León, Monterrey, Mexico. 27. Division of Digestive and Liver Diseases, Department of Medicine and Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA. 28. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA. 29. Liver Unit, Clinica Universidad de Navarra, IdisNA. Pamplona, Spain. 30. Liver Unit and Digestive Department H.G.U. Gregorio Marañón, Madrid, Spain. 31. CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. 32. Glasgow Royal Infirmary, Glasgow, UK. 33. Liver Unit, Cambridge Biomedical Research Centre, Cambridge, UK.
Abstract
INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
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