Can J Gastroenterol Hepatol. 2015 Apr;29(3):131-8. doi: 10.1155/2015/814827.
Severe alcoholic hepatitis (AH) is associated with a substantial risk for short-term mortality.
To identify prognostic factors and validate well-known prognostic models in a Canadian population of patients hospitalized for AH.
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.
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).
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.
严重酒精性肝炎（AH）与短期死亡率有很大的关系。
在加拿大 AH 住院患者人群中确定预后因素并验证已知的预后模型。
在这项回顾性研究中，纳入了 2008 年 1 月至 2012 年 8 月在阿尔伯塔省卡尔加里住院的 AH 患者。逐步逻辑回归模型确定了 90 天死亡率的独立危险因素，并通过 ROC 曲线下面积来检验预后模型（终末期肝病模型 [MELD]和 Maddrey 判别函数 [DF]）的区分能力。
研究期间共有 122 例 AH 患者住院，中位年龄为 49 岁（四分位间距 [IQR] 42-55 岁），60%为男性。入院时中位 MELD 评分和 Maddrey DF 分别为 21（IQR 18-24）和 45（IQR 26-62）。73%的患者接受了皮质激素和/或己酮可可碱治疗，90 天死亡率为 17%。死亡率的独立预测因素包括年龄较大、女性、国际标准化比值、MELD 评分和 Maddrey DF（均 P<0.05）。对于 90 天死亡率的判别，预后模型的 ROC 曲线下面积（MELD 为 0.64；Maddrey DF 为 0.68）相似（P>0.05）。在 MELD 评分≥22 和 Maddrey DF≥37 的最佳截断值下，两种模型都可以高度确定排除死亡（阴性预测值分别为 90%和 96%）。
在 AH 住院患者中，可使用已知的预后模型预测 90 天死亡率，尤其是可以识别低死亡风险的患者。
