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Risk factors for mortality in patients with alcoholic hepatitis and assessment of prognostic models: A
Insights
Prognostic models like MELD and Maddrey DF accurately predict 90-day mortality in alcoholic hepatitis patients in Canada. These tools are especially useful for identifying patients with a low risk of death.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Prognostics
Background:
- Severe alcoholic hepatitis (AH) presents a significant risk of short-term mortality.
- Accurate prognostication is crucial for managing AH patients.
Purpose of the Study:
- To identify prognostic factors for 90-day mortality in Canadian AH patients.
- To validate established prognostic models (MELD, Maddrey DF) in this population.
Main Methods:
- Retrospective analysis of 122 hospitalized AH patients in Calgary (2008-2012).
- Logistic regression identified independent risk factors for 90-day mortality.
- Area Under the ROC Curve (AUC) evaluated model discrimination.
Main Results:
- 17% of patients died within 90 days.
- Independent predictors of mortality included age, female sex, INR, MELD score, and Maddrey DF.
- MELD (AUC 0.64) and Maddrey DF (AUC 0.68) showed similar discrimination.
- High negative predictive values (90% MELD, 96% Maddrey DF) identified low-risk patients.
Conclusions:
- Established prognostic models are effective for predicting 90-day mortality in hospitalized AH patients.
- These models are particularly valuable for identifying patients with a low likelihood of death.
Background:
Severe alcoholic hepatitis (AH) is associated with a substantial risk for short-term mortality.
Objectives:
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.
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