title: Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort.
abstract: BACKGROUND
  Several prognostic models have emerged in alcoholic hepatitis (AH), but lack of external validation precludes their universal use.
  
  
  OBJECTIVE
  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.
authors.forename: V
authors.initials: V
authors.lastname: Papastergiou
authors.forename: E A
authors.initials: EA
authors.lastname: Tsochatzis
authors.forename: G
authors.initials: G
authors.lastname: Pieri
authors.forename: E
authors.initials: E
authors.lastname: Thalassinos
authors.forename: A
authors.initials: A
authors.lastname: Dhar
authors.forename: S
authors.initials: S
authors.lastname: Bruno
authors.forename: S
authors.initials: S
authors.lastname: Karatapanis
authors.forename: T V
authors.initials: TV
authors.lastname: Luong
authors.forename: J
authors.initials: J
authors.lastname: O'Beirne
authors.forename: D
authors.initials: D
authors.lastname: Patch
authors.forename: D
authors.initials: D
authors.lastname: Thorburn
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006519:Hepatitis, Alcoholic / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index