Skip to main content

Advertisement

SpringerLink
Log in

Predicting Short-Term Mortality and Long-Term Survival for Hospitalized US Patients with Alcoholic Hepatitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

No study has evaluated current scoring systems for their accuracy in predicting short and long-term outcome of alcoholic hepatitis in a US population.

Methods

We reviewed electronic records for patients with alcoholic liver disease (ALD) admitted to Parkland Memorial Hospital between January 2002 and August 2005. Data and outcomes for 148 of 1,761 admissions meeting pre-defined criteria were collected. The discriminant function (DF) was revised (INRdf) to account for changes in prothrombin time reagents that could potentially affect identification of risk using the previous DF threshold of >32. Admission and theoretical peak scores were calculated by use of the Model for End-stage Liver Disease (MELD). Analysis models compared five different scoring systems.

Results

INRdf was closely correlated with the old DF (r 2 = 0.95). Multivariate analysis of the data showed that survival for 28 days was significantly associated with a scoring system using a combination of age, bilirubin, coagulation status, and creatinine (p < 0.001), and an elevated ammonia result within two days of admission (p = 0.012). When peak values for MELD were included, they were the most significant predictor of short-term mortality (p < 0.001), followed by INRdf (p = 0.006).

Conclusion

On admission, two scoring systems that identify a subset of patients with severe alcoholic liver disease are able to predict >50 % mortality at four weeks and >80 % mortality at six months without specific treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ABIC score:

Age, bilirubin, INR, creatinine score

ALD:

Alcoholic liver disease

DF:

Discriminant function

GAHS:

Glasgow alcoholic hepatitis score

INRdf:

Modified DF using INR

INR:

International normalized ratio

ISI:

Internal sensitivity index

MELD:

Model of End-stage Liver Disease

HCV:

Chronic hepatitis C

PT:

Prothrombin time

WBC:

White blood cell

References

  1. Maddrey WC. Alcoholic hepatitis: pathogenesis and approaches to treatment. Scand J Gastroenterol Suppl. 1990;175:118–130.

    Article  CAS  PubMed  Google Scholar 

  2. Mathurin P, Duchatelle V, Ramond MJ, et al Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology. 1996;110:1847–1853.

    Article  CAS  PubMed  Google Scholar 

  3. Mathurin P, Louvet A, Dharancy S. Treatment of severe forms of alcoholic hepatitis: where are we going? J Gastroenterol Hepatol. 2008;23:S60–S62.

    Article  CAS  PubMed  Google Scholar 

  4. Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut. 1995;37:113–118.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. McCullough AJ, O’Connor JF. Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology. Am J Gastroenterol. 1998;93:2022–2036.

    Article  CAS  PubMed  Google Scholar 

  6. Mathurin P. Corticosteroids for alcoholic hepatitis–what’s next? J Hepatol. 2005;43:526–533.

    Article  PubMed  Google Scholar 

  7. Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C. Systematic review: glucocorticosteroids for alcoholic hepatitis—a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. Aliment Pharmacol Ther. 2008;27:1167–1178.

    Article  CAS  PubMed  Google Scholar 

  8. O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;51:307–328.

    Article  PubMed  Google Scholar 

  9. Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology. 1978;75:193–199.

    CAS  PubMed  Google Scholar 

  10. Carithers RL Jr, Herlong HF, Diehl AM, et al Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med. 1989;110:685–690.

    Article  PubMed  Google Scholar 

  11. Robert A, Chazouilleres O. Prothrombin time in liver failure: time, ratio, activity percentage, or international normalized ratio? Hepatology. 1996;24:1392–1394.

    Article  CAS  PubMed  Google Scholar 

  12. Tripodi A, Poller L, van den Besselaar AM, Mannucci PM. A proposed scheme for calibration of international reference preparations of thromboplastin for the prothrombin time. On behalf of the Subcommittee on Control of Anticoagulation. Thromb Haemost. 1995;74:1368–1369.

    CAS  PubMed  Google Scholar 

  13. Poller L, Keown M, Chauhan N, et al European concerted action on anticoagulation. Evaluation of a method for International Sensitivity Index calibration of two point-of-care prothrombin time (PT) monitoring systems (CoaguChek Mini and TAS PT-NC) with fresh plasmas based on whole-blood equivalent PT. Clin Chem. 2002;48:1672–1680.

    CAS  PubMed  Google Scholar 

  14. Forrest EH, Evans CD, Stewart S, et al Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score. Gut. 2005;54:1174–1179.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Dominguez M, Rincon D, Abraldes JG, et al A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol. 2008;103:2747–2756.

    Article  PubMed  Google Scholar 

  16. Sandahl TD, Jepsen P, Ott P, Vilstrup H. Validation of prognostic scores for clinical use in patients with alcoholic hepatitis. Scand J Gastroenterol. 2011;46:1127–1132.

    Article  PubMed  Google Scholar 

  17. Palaniyappan N, Subramanian V, Ramappa V, Ryder SD, Kaye P, Aithal GP. The utility of scoring systems in predicting early and late mortality in alcoholic hepatitis: whose score is it anyway? Int J Hepatol. 2012;2012:624675.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Lafferty H, Stanley AJ, Forrest EH. The management of alcoholic hepatitis: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2013;38:603–610.

    Article  CAS  PubMed  Google Scholar 

  19. Altamirano J, Higuera-de laTijera F, Duarte-Rojo A et al The amount of alcohol consumption negatively impacts short-term mortality in Mexican patients with alcoholic hepatitis. Am J Gastroenterol. 2011;106:1472–1480.

    Google Scholar 

  20. UNOS. MELD/PELD calculator documentation. http://www.unos.org/docs/MELD_PELD_Calculator_Documentation.pdf. 2009.

  21. Mathurin P, O’Grady J, Carithers RL, et al Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut. 2011;60:255–260.

    Article  CAS  PubMed  Google Scholar 

  22. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:1637–1648.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are indebted to Dwain Thiele, M.D. for questioning the validity of the discriminant function in an era of changing prothrombin reagents, for deriving the equation comparing results before and after, and for working with members of the coagulation laboratory at Parkland Health and Hospital System to validate the relationship by comparing >1,000 results in tandem. This study was supported in part by NIH U01-AA021893.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Parkland Memorial Hospital, Parkland Health and Hospital System, Dallas, TX, USA

    Jennifer A. Cuthbert, Sami Arslanlar, Jay Yepuri & Jessica P. Shah

  2. Department of Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9139, USA

    Jennifer A. Cuthbert, Sami Arslanlar, Jay Yepuri & Jessica P. Shah

  3. Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, 75390-9139, USA

    Chul W. Ahn

  4. Texas State Department of Health Statistics, Austin, TX, USA

    Marc Montrose

Authors
  1. Jennifer A. Cuthbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sami Arslanlar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jay Yepuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Montrose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chul W. Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica P. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer A. Cuthbert.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 328 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cuthbert, J.A., Arslanlar, S., Yepuri, J. et al. Predicting Short-Term Mortality and Long-Term Survival for Hospitalized US Patients with Alcoholic Hepatitis. Dig Dis Sci 59, 1594–1602 (2014). https://doi.org/10.1007/s10620-013-3020-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-3020-3

Keywords

Search

Navigation