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Short-Term Risk Stratification in Alcohol-Associated Hepatitis: Small HDL Particles and Inflammation Vulnerability
Eduardo Vilar-Gomez1, Margery A Connelly2, Vijay H Shah3
1Division of Gastroenterology & Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Alcohol, Clinical & Experimental Research
|August 10, 2026
Summary
Small high-density lipoprotein particles (S-HDL-P) can improve 90-day mortality prediction in alcohol-associated hepatitis (AH). Lower S-HDL-P is linked to higher short-term mortality, suggesting it can refine risk scores beyond MELD.
Area of Science:
- Hepatology
- Biomarkers
- Medical Diagnostics
Background:
- Alcohol-associated hepatitis (AH) presents high short-term mortality.
- Current prognostic models primarily assess liver and renal function.
- The Metabolic Vulnerability Index (MVX) incorporates Inflammation Vulnerability Index (IVX) and Metabolic Malnutrition Index (MMX).
Purpose of the Study:
- To evaluate if MVX, IVX, and their components enhance 90-day mortality prediction in AH.
- To determine if S-HDL-P and GlycA improve upon the Model for End-Stage Liver Disease (MELD) score.
Main Methods:
- Nuclear magnetic resonance spectroscopy analyzed serum samples from 196 AH patients and controls.
- Cox models assessed 90-day mortality, adjusting for MELD, age, sex, and other clinical factors.
- Model performance was evaluated using AIC, likelihood-ratio testing, and C-statistic.
Main Results:
- Lower S-HDL-P was independently associated with increased 90-day mortality (HR, 1.84; p=0.045).
- Adding S-HDL-P improved MELD-based model fit (AIC, 298.97 vs. 301.46; LR p=0.034).
- IVX also showed supportive improvement in model fit and discrimination.
Conclusions:
- Lower S-HDL-P is a key short-term prognostic factor in AH.
- S-HDL-P and IVX may refine MELD-based 90-day risk stratification for AH patients.
- External validation is recommended for these findings.
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