A New Scoring System for Prognostic Stratification of Patients With Alcoholic Hepatitis

• DOI: 10.1111/j.1572-0241.2008.02104.x
• Publication Date: 2008-08-21T16:05:10Z
• Authors: Marlene Dominguez; Diego Rincón; Juan G. Abraldes; Rosa Miquel; Jordi Colmenero; Pablo Bellot; Joan-Carles Garcí...; Rosamelia Fernández; Montserrat Moreno; Rafael Bañares; Vicente Arroyo; Joan Caballería; Pere Ginès; Ramón Bataller
• Keywords: Adult; Male; 0301 basic medicine; Hepatitis, Alcoholic; Middle Aged; Prognosis; Risk Assessment; Severity of Illness Index; 3. Good health; 03 medical and health sciences; Humans; Female; Prospective Studies; Aged

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.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.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).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.