title: Risk factors for mortality in patients with alcoholic hepatitis and assessment of prognostic models: A population-based study.
abstract: BACKGROUND
  Severe alcoholic hepatitis (AH) is associated with a substantial risk for short-term mortality.
  
  
  OBJECTIVE
  To identify prognostic factors and validate well-known prognostic models in a Canadian population of patients hospitalized for AH.
  
  
  METHODS
  In the present retrospective study, patients hospitalized for AH in Calgary, Alberta, between January 2008 and August 2012 were included. Stepwise logistic regression models identified independent risk factors for 90-day mortality, and the discrimination of prognostic models (Model for End-stage Liver Disease [MELD] and Maddrey discriminant function [DF]) were examined using areas under the ROC curves.
  
  
  RESULTS
  A total of 122 patients with AH were hospitalized during the study period; the median age was 49 years (interquartile range [IQR] 42 to 55 years) and 60% were men. Median MELD score and Maddrey DF on admission were 21 (IQR 18 to 24) and 45 (IQR 26 to 62), respectively. Seventy-three percent of patients received corticosteroids and⁄or pentoxifylline, and the 90-day mortality was 17%. Independent predictors of mortality included older age, female sex, international normalized ratio, MELD score and Maddrey DF (all P<0.05). For discrimination of 90-day mortality, the areas under the ROC curves of the prognostic models (MELD 0.64; Maddrey DF 0.68) were similar (P>0.05). At optimal cut-offs of ≥22 for MELD score and ≥37 for Maddrey DF, both models excluded death with high certainty (negative predictive values 90% and 96%, respectively).
  
  
  CONCLUSIONS
  In patients hospitalized for AH, well-known prognostic models can be used to predict 90-day mortality, particularly to identify patients with a low risk for death.
authors: Jack X Q
authors: JX
authors: Pang
authors: Erin
authors: E
authors: Ross
authors: Meredith A
authors: MA
authors: Borman
authors: Scott
authors: S
authors: Zimmer
authors: Gilaad G
authors: GG
authors: Kaplan
authors: Steven J
authors: SJ
authors: Heitman
authors: Mark G
authors: MG
authors: Swain
authors: Kelly
authors: K
authors: Burak
authors: Hude
authors: H
authors: Quan
authors: Robert P
authors: RP
authors: Myers
mesh_terms: D000328:Adult; D017677:Age Distribution; D000416:Alberta / Q000453:epidemiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D019934:International Normalized Ratio; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution