Digestive Diseases and Sciences

, Volume 59, Issue 7, pp 1594–1602

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

  • Jennifer A. Cuthbert
  • Sami Arslanlar
  • Jay Yepuri
  • Marc Montrose
  • Chul W. Ahn
  • Jessica P. Shah
Original Article

DOI: 10.1007/s10620-013-3020-3

Cite this article as:
Cuthbert, J.A., Arslanlar, S., Yepuri, J. et al. Dig Dis Sci (2014) 59: 1594. doi:10.1007/s10620-013-3020-3

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 (r2 = 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.

Keywords

Discriminant function Model of End-stage Liver Disease Prothrombin time Internal sensitivity index Alcoholic hepatitis scores 

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

Supplementary material

10620_2013_3020_MOESM1_ESM.docx (328 kb)
Supplementary material 1 (DOCX 328 kb)

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jennifer A. Cuthbert
    • 1
    • 2
  • Sami Arslanlar
    • 1
    • 2
  • Jay Yepuri
    • 1
    • 2
  • Marc Montrose
    • 4
  • Chul W. Ahn
    • 3
  • Jessica P. Shah
    • 1
    • 2
  1. 1.Parkland Memorial HospitalParkland Health and Hospital SystemDallasUSA
  2. 2.Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of Clinical SciencesThe University of Texas Southwestern Medical CenterDallasUSA
  4. 4.Texas State Department of Health StatisticsAustinUSA

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