New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey’s discriminant function <32

• Published in: Hepatology international 2024-04, Vol.18 (2), p.500-508
• Main Authors: Kim, Tae Hyung, Yim, Hyung Joon, Jung, Young Kul, Song, Do Seon, Yoon, Eileen L., Kim, Hee Yeon, Kang, Seong Hee, Chang, Young, Yoo, Jeong-Ju, Jun, Baek Gyu, Lee, Sung Won, Park, Jung Gil, Park, Ji Won, Kim, Sung-Eun, Kim, Tae Yeob, Jeong, Soung Won, Suk, Ki Tae, Kim, Moon Young, Kim, Sang Gyune, Kim, Won, Jang, Jae Young, Yang, Jin Mo, Kim, Dong Joon
• Format: Article
• Language: English
• Subjects: Acute-On-Chronic Liver Failure - complications; Ascites; Cirrhosis; Colorectal Surgery; Discriminant analysis; Hepatitis; Hepatitis, Alcoholic - complications; Hepatology; Humans; Hyponatremia; Leukocytes (neutrophilic); Liver; Liver cirrhosis; Liver Cirrhosis, Alcoholic; Liver transplantation; Liver transplants; Medical prognosis; Medicine; Medicine & Public Health; Mortality; NCT; NCT02650011; Original Article; Preempting; Prognosis; Prospective Studies; Retrospective Studies; Severity of Illness Index; Surgery; Transplantation
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-023-10582-1

Background & aims Few studies have investigated the prognosis of patients with non-severe alcoholic hepatitis (Non-SAH). The study aimed to develop a new prognostic model for patients with especially Non-SAH. Methods We extracted 316 hospitalized patients with alcoholic cirrhosis without severe alcoholic hepatitis, defined as Maddrey’s discriminant function score lower than 32, from the retrospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort to develop a new prognostic model (training set), and validated it in 419 patients from the prospective KACLiF cohort (validation set). Prognostic factors for death and liver transplantation were analyzed to construct a prognostic model. Results Twenty-one and 24 patients died within 6 months in both sets, respectively. In the training set, the highest area under the curve (AUC) of conventional prognostic models was 0.765, 0.732, and 0.684 for 1-, 3-, and 6-month mortality, respectively. Refractory ascites, vasopressor use, and hyponatremia were independently associated with mortality of cirrhotic patients with Non-SAH. The new model consisted of four variables: past deterioration, neutrophil proportion > 70%, Na < 128 mmol/L, and vasopressor use. It showed the highest accuracy for short-term mortality in the training and validation sets (0.803 and 0.786; 0.797 and 0.776; and 0.789 and 0.721 for 1-, 3-, and 6-month mortality, respectively). Conclusion There is a group of patients with high risk among those classified as Non-SAH. The new model will help stratifying cirrhotic patients with Non-SAH more accurately in terms of prognosis. The patients with high Non-SAH score need to monitor closely and might be considered for preemptive liver transplantation. Trial regestration ClinicalTrials.gov identifier: NCT02650011.