Combining Data From Liver Disease Scoring Systems Better Predicts Outcomes of Patients With Alcoholic Hepatitis.
OBJECTIVE
Several models have been used to determine prognoses of patients with alcoholic hepatitis. These include static systems (the Maddrey discriminant function; age, bilirubin, international normalized ratio, creatinine [ABIC] score; and model for end-stage liver disease [MELD] score) and dynamic models (the Lille model). We aimed to combine features of all of these models to develop a better method to predict outcomes of patients with alcoholic hepatitis.


METHODS
We collected data from several databases of patients with severe alcoholic hepatitis treated with corticosteroids in France and the United Kingdom to create a model to predict patient survival (derivation cohort, n = 538 patients). We compared the performances of 3 joint-effect models (Maddrey+Lille, MELD+Lille, and ABIC+Lille) to determine which combination had the best prognostic value, based on known patient outcomes. The model was validated using data from trials of the effects of corticosteroids in patients in the United States, France, Korea, and Belgium (n = 604 patients).


RESULTS
We created a joint-effect model to predict patient survival after 2 and 6 months; in the derivation and validation cohorts it predicted outcome significantly better than either static or dynamic models alone (P < .01 for all comparisons). The joint model accurately predicted patient survival regardless of patient risk level. The MELD+Lille combination was better than the Maddrey+Lille or ABIC+Lille combination in predicting patient survival, with Akaike information criterion values of 1305, 1313, and 1312, respectively. For example, based on the MELD+Lille combination model, the predicted 6-month mortality of complete responders with MELD scores of 15-45 (Lille score, 0.16) was 8.5% to 49.7%, compared with 16.4%-75.2% for nonresponders (Lille score, 0.45). According to the joint-effect model, for 2 patients with the same baseline MELD score of 21, the patient with a Lille score of 0.45 had a 1.9-fold higher risk of death than the patient with a Lille score of 0.16 (23.7% vs 12.5%).


CONCLUSIONS
By combining results from static and dynamic scoring systems for liver disease, we can better predict outcomes of patients with alcoholic hepatitis, compared with either model alone. This may help patient management and design of clinical trials.
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France.
Alexandre
A
Louvet
Unité de Biostatistiques, CHRU, Lille, France.
Julien
J
Labreuche
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France.
Florent
F
Artru
Service d'Hépato-Gastroentérologie, CHU, Angers, France.
Jérôme
J
Boursier
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Dong Joon
DJ
Kim
Liver Unit, King's College, London, United Kingdom.
John
J
O'Grady
Service de Gastroentérologie et d'Hépato-Pancréatologie, Hôpital Erasme, Brussels, Belgium.
Eric
E
Trépo
Service d'Hépato-Gastroentérologie, Hôpital Jean-Verdier, APHP, Bondy, France.
Pierre
P
Nahon
Service d'Hépato-Gastroentérologie, Hôpital Jean-Verdier, APHP, Bondy, France.
Nathalie
N
Ganne-Carrié
Service d'Hépato-Gastroentérologie, Hôpital Béclère, APHP, Clamart, France.
Sylvie
S
Naveau
Service d'Hépato-Gastroentérologie, Béthune, France.
Emmanuel
E
Diaz
Service de Gastroentérologie et d'Hépato-Pancréatologie, Hôpital Erasme, Brussels, Belgium.
Thierry
T
Gustot
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France.
Guillaume
G
Lassailly
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France.
Amélie
A
Cannesson-Leroy
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France.
Valérie
V
Canva-Delcambre
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France.
Sébastien
S
Dharancy
Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea.
Seung Ha
SH
Park
Service de Gastroentérologie et d'Hépato-Pancréatologie, Hôpital Erasme, Brussels, Belgium.
Christophe
C
Moreno
VA Long Beach Healthcare System, Long Beach, California.
Timothy R
TR
Morgan
Unité de Biostatistiques, CHRU, Lille, France.
Alain
A
Duhamel
Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Lille, France; Unité INSERM U995, Lille, France. Electronic address: philippe.mathurin@chru-lille.fr.
Philippe
P
Mathurin
D000328:Adult; D000375:Aging / Q000473:pathology*; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005602:France; D006519:Hepatitis, Alcoholic / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D006113:United Kingdom
D003404:Creatinine; D001663:Bilirubin
AH; Cirrhosis; Classification; Prognostic Factor