A new scoring system for prognostic stratification of patients with alcoholic hepatitis.
OBJECTIVE
Prognostic stratification of patients with alcoholic hepatitis (AH) may improve the clinical management and facilitate clinical trials. We aimed at developing a scoring system capable of providing prognostic stratification of patients with AH.


METHODS
Patients with biopsy-proven AH were prospectively included between 2000 and 2006. The biochemical, clinical, portal hemodynamic and histological parameters were evaluated. A Cox regression model was used for univariate and multivariate analyses. A predictive score was built using variables obtained at admission identified in the multivariate analysis. The resulting score was validated in an independent prospective cohort.


RESULTS
In total, 103 patients with biopsy-proven AH were included in the study cohort. Age, serum bilirubin, serum creatinine, and international normalized ratio (INR) independently predicted 90-day mortality. We generated the Age, serum Bilirubin, INR, and serum Creatinine (ABIC) score: (age x 0.1) + (serum bilirubin x 0.08) + (serum creatinine x 0.3) + (INR x 0.8). The area under the curve (AUC) was 0.82. Using the Kaplan-Meier analysis with the cutoff values of 6.71 and 9.0, we identified patients with low, intermediate, and high risk of death at 90 days (100%, 70%, and 25% of survival rate, respectively). Using the same cutoff values, the ABIC score also stratified patients according to their risk of death at 1 yr. These results were validated by a confirmatory cohort (N = 80).


CONCLUSIONS
The ABIC score is a new tool that allows the stratification of risk of death in patients with AH at 90 days and 1 yr. This score can help improve the management of these patients and also help to perform clinical trials.
Dominguez
Marlene
M
Liver Unit, Institut Clínic Malalties Digestives i Metabòliques, Hospital Clinic, and Centro de Investigación Biomédica Esther Koplowitz, Barcelona, Catalonia, Spain.
Rincón
Diego
D
Abraldes
Juan G
JG
Miquel
Rosa
R
Colmenero
Jordi
J
Bellot
Pablo
P
García-Pagán
Joan-Carles
JC
Fernández
Rosamelia
R
Moreno
Montserrat
M
Bañares
Rafael
R
Arroyo
Vicente
V
Caballería
Joan
J
Ginès
Pere
P
Bataller
Ramón
R
D000328:Adult; D000368:Aged; D005260:Female; D006519:Hepatitis, Alcoholic / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index