Ivica Grgurević, Department of Gastroenterology, Hepatology, and Clinical Nutrition, Department of Medicine, Dubrava University Hospital, Avenija Gojka Šuška 6, Zagreb 10 000, Croatia,
Croat Med J. 2021 Feb 28;62(1):17-24. doi: 10.3325/cmj.2021.62.17.
To explore the prognostic value of modified Discriminant Function (mDF), Glasgow Alcoholic Hepatitis Score (GAHS), Model of End Stage Liver Disease (MELD), Age-Bilirubin-International Normalized Ratio-Creatinine score (ABIC), and the Lille Model for the 28- and 90-day mortality in patients with alcoholic hepatitis.
This retrospective study enrolled patients treated for alcoholic hepatitis in Dubrava University Hospital between January 2014 and May 2018. The diagnosis was established based on histology findings or the combination of patient´s history of ongoing alcohol consumption before hospitalization, serum bilirubin above 50 mmol/L, and aspartate transaminase to alanine transaminase ratio greater than 1.5. We calculated mDF, MELD, GAHS, and ABIC on the first and seventh day of hospitalization (including the Lille model).
In total, 70 patients were enrolled. ABIC at admission most accurately predicted the 28-day mortality, with a cut-off of 9.92 (AUC 0.727; 95% CI 0.608-0.827, P=0.0119), while GAHS most accurately predicted the 90-day mortality, calculated both at admission (cut off >7, AUC 0.765, 95% CI 0.639-0.864, P<0.0001) and after seven days of hospitalization (cut-off >8, AUC 0.835 95% CI 0.716-0.918, P<0.0001). Modified DF was able to predict the 28- and 90-day mortality only when calculated after seven days of hospitalization.
There is a need for better prognostic indicators for patients with AH.
探讨改良判别函数（mDF）、格拉斯哥酒精性肝炎评分（GAHS）、终末期肝病模型（MELD）、年龄-胆红素-国际标准化比值-肌酐评分（ABIC）和利尔模型对酒精性肝炎患者 28 天和 90 天死亡率的预后价值。
本回顾性研究纳入了 2014 年 1 月至 2018 年 5 月在杜布拉瓦大学医院接受酒精性肝炎治疗的患者。诊断依据为组织学检查结果或患者住院前持续饮酒史、血清胆红素>50mmol/L 以及天冬氨酸转氨酶/丙氨酸转氨酶比值>1.5。我们在住院的第 1 天和第 7 天计算了 mDF、MELD、GAHS 和 ABIC（包括利尔模型）。
共纳入 70 例患者。入院时 ABIC 最能准确预测 28 天死亡率，截断值为 9.92（AUC 0.727；95%CI 0.608-0.827，P=0.0119），而 GAHS 最能准确预测 90 天死亡率，无论是入院时（截断值>7，AUC 0.765，95%CI 0.639-0.864，P<0.0001）还是住院第 7 天计算（截断值>8，AUC 0.835 95%CI 0.716-0.918，P<0.0001）。只有在住院第 7 天后计算时，mDF 才能预测 28 天和 90 天的死亡率。
需要更好的预后指标来预测 AH 患者的预后。
