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Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort

BACKGROUND: Several prognostic models have emerged in alcoholic hepatitis (AH), but lack of external validation precludes their universal use. AIM: To validate the Maddrey Discriminant Function (DF); Glasgow Alcoholic Hepatitis Score (GAHS); Mayo End-stage Liver Disease (MELD); Age, Bilirubin, INR,...

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Autores principales: Papastergiou, V, Tsochatzis, E A, Pieri, G, Thalassinos, E, Dhar, A, Bruno, S, Karatapanis, S, Luong, T V, O'Beirne, J, Patch, D, Thorburn, D, Burroughs, A K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015369/
https://www.ncbi.nlm.nih.gov/pubmed/24612165
http://dx.doi.org/10.1111/apt.12654
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author Papastergiou, V
Tsochatzis, E A
Pieri, G
Thalassinos, E
Dhar, A
Bruno, S
Karatapanis, S
Luong, T V
O'Beirne, J
Patch, D
Thorburn, D
Burroughs, A K
author_facet Papastergiou, V
Tsochatzis, E A
Pieri, G
Thalassinos, E
Dhar, A
Bruno, S
Karatapanis, S
Luong, T V
O'Beirne, J
Patch, D
Thorburn, D
Burroughs, A K
author_sort Papastergiou, V
collection PubMed
description BACKGROUND: Several prognostic models have emerged in alcoholic hepatitis (AH), but lack of external validation precludes their universal use. AIM: To validate 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 three scores of corticosteroid response at 1 week: an Early Change in Bilirubin Levels (ECBL), a 25% fall in bilirubin, and the Lille score. METHODS: Seventy-one consecutive patients with biopsy-proven AH, admitted between November 2007-September 2011, were evaluated. The clinical and biochemical parameters were analysed to assess prognostic models with respect to 30- and 90-day mortality. RESULTS: There were no significant differences in the areas under the receiver operating characteristics curve (AUROCs) relative to 30-day/90-day mortality: MELD 0.79/0.84, DF 0.71/0.74, GAHS 0.75/0.78, ABIC 0.71/0.78, MELD-Na 0.68/0.76, UKELD 0.56/0.68. One-week rescoring yielded a trend towards improved predictive accuracies (30-day/90-day AUROCs: 0.69–0.84/0.77–0.86). In patients with admission DF ≥32 (n = 31), 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. All models showed excellent negative predictive values (NPVs; range: 86–100%), while the positive ones were low (range: 17–50%). CONCLUSIONS: 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 NPVs, the models are best to identify patients at low risk of death.
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spelling pubmed-40153692014-05-12 Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort Papastergiou, V Tsochatzis, E A Pieri, G Thalassinos, E Dhar, A Bruno, S Karatapanis, S Luong, T V O'Beirne, J Patch, D Thorburn, D Burroughs, A K Aliment Pharmacol Ther Alcoholic Hepatitis BACKGROUND: Several prognostic models have emerged in alcoholic hepatitis (AH), but lack of external validation precludes their universal use. AIM: To validate 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 three scores of corticosteroid response at 1 week: an Early Change in Bilirubin Levels (ECBL), a 25% fall in bilirubin, and the Lille score. METHODS: Seventy-one consecutive patients with biopsy-proven AH, admitted between November 2007-September 2011, were evaluated. The clinical and biochemical parameters were analysed to assess prognostic models with respect to 30- and 90-day mortality. RESULTS: There were no significant differences in the areas under the receiver operating characteristics curve (AUROCs) relative to 30-day/90-day mortality: MELD 0.79/0.84, DF 0.71/0.74, GAHS 0.75/0.78, ABIC 0.71/0.78, MELD-Na 0.68/0.76, UKELD 0.56/0.68. One-week rescoring yielded a trend towards improved predictive accuracies (30-day/90-day AUROCs: 0.69–0.84/0.77–0.86). In patients with admission DF ≥32 (n = 31), 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. All models showed excellent negative predictive values (NPVs; range: 86–100%), while the positive ones were low (range: 17–50%). CONCLUSIONS: 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 NPVs, the models are best to identify patients at low risk of death. John Wiley & Sons 2014-04 2014-02-12 /pmc/articles/PMC4015369/ /pubmed/24612165 http://dx.doi.org/10.1111/apt.12654 Text en © 2014 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Alcoholic Hepatitis
Papastergiou, V
Tsochatzis, E A
Pieri, G
Thalassinos, E
Dhar, A
Bruno, S
Karatapanis, S
Luong, T V
O'Beirne, J
Patch, D
Thorburn, D
Burroughs, A K
Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title_full Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title_fullStr Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title_full_unstemmed Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title_short Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
title_sort nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort
topic Alcoholic Hepatitis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015369/
https://www.ncbi.nlm.nih.gov/pubmed/24612165
http://dx.doi.org/10.1111/apt.12654
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