Spontaneous Evolution in Bilirubin Levels Predicts Liver-Related Mortality in Patients with Alcoholic Hepatitis

Abstract

The accurate prognostic stratification of alcoholic hepatitis (AH) is essential for individualized therapeutic decisions. The aim of this study was to develop a new prognostic model to predict liver-related mortality in Asian AH patients. We conducted a hospital-based, retrospective cohort study using 308 patients with AH between 1999 and 2011 (a derivation cohort) and 106 patients with AH between 2005 and 2012 (a validation cohort). The Cox proportional hazards model was constructed to select significant predictors of liver-related death from the derivation cohort. A new prognostic model was internally validated using a bootstrap sampling method. The discriminative performance of this new model was compared with those of other prognostic models using a concordance index in the validation cohort. Bilirubin, prothrombin time, creatinine, potassium at admission, and a spontaneous change in bilirubin levels from day 0 to day 7 (SCBL) were incorporated into a model for AH to grade the severity in an Asian patient cohort (MAGIC). For risk stratification, four risk groups were identified with cutoff scores of 29, 37, and 46 based on the different survival probabilities (P<0.001). In addition, MAGIC showed better discriminative performance for liver-related mortality than any other scoring system in the validation cohort. MAGIC can accurately predict liver-related mortality in Asian patients hospitalized for AH. Therefore, SCBL may help us decide whether patients with AH urgently require corticosteroid treatment.

Roseburia spp. Abundance Associates with Alcohol Consumption in Humans and Its Administration Ameliorates Alcoholic Fatty Liver in Mice

“…A total of 22 fecal samples from patients with ALD were collected from the previous study (Kim et al, 2016a;Kim et al, 2016b;Lee et al, 2014) as a validation cohort. In the validation cohort, no patient used the concomitant medications such as antibiotics, protonpump inhibitor (PPI) and immunosuppression.…”

Prognostic Indexes for Alcoholic Hepatitis

“…Prognostic model of Asian patient cohort (MA-GIC) were also lately presented and includes the following parameters: bilirubin, prothrombin time, creatinine, potassium at admission, and a spontaneous change in bilirubin levels from day 0 to day 7. MAGIC was able to accurately predict mortality in Asian patients with severe AH [43].…”

Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis

“… 12 - 17 Diagnosis of AH was based on the overall pattern of histological injury including hepatocellular damage (presence of Mallory bodies and hepatocellular ballooning), inflammatory infiltrate polymorphonuclear leukocytes, and pericellular fibrosis. 8 - 22 In order to evaluate a possible association between short-term outcomes and the AHHS score, we graded the severity of fibrosis, type of bilirubinostasis, degree of neutrophil infiltration, and presence of megamitochondria. 17 …”

“… 6 , 7 Other validated models include the ABIC (age, serum bilirubin, international normalized ratio, and serum creatine) score, the Lille score, and the Glasgow alcoholic hepatitis score, and the MAGIC (model for AH to grade severity in an Asian patient cohort) score. 8 - 11 Although biochemical data can be used to predict clinical outcome, AH is likely the only chronic liver disease that lacks a validated histological classification.…”