Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea.
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Hepatol Int. 2024 Apr;18(2):500-508. doi: 10.1007/s12072-023-10582-1. Epub 2023 Oct 13.
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.
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.
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).
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.
ClinicalTrials.gov identifier: NCT02650011.
很少有研究调查非严重酒精性肝炎（Non-SAH）患者的预后。本研究旨在为特别是 Non-SAH 患者开发一种新的预后模型。
我们从回顾性韩国急性慢性肝衰竭（KACLiF）队列中提取了 316 名患有酒精性肝硬化但无严重酒精性肝炎的住院患者，定义为 Maddrey 判别函数评分低于 32，用于开发新的预后模型（训练集），并在前瞻性 KACLiF 队列的 419 名患者中进行验证（验证集）。分析死亡和肝移植的预后因素以构建预后模型。
在两组中，分别有 21 例和 24 例患者在 6 个月内死亡。在训练集中，传统预后模型的最高曲线下面积（AUC）分别为 1 个月、3 个月和 6 个月死亡率的 0.765、0.732 和 0.684。难治性腹水、血管加压素使用和低钠血症与 Non-SAH 肝硬化患者的死亡率独立相关。新模型由四个变量组成：过去恶化、中性粒细胞比例>70%、Na<128mmol/L 和血管加压素使用。该模型在训练集和验证集中对短期死亡率的准确性最高（1 个月、3 个月和 6 个月死亡率分别为 0.803 和 0.786；0.797 和 0.776；0.789 和 0.721）。
在分类为 Non-SAH 的患者中，存在一组高风险患者。新模型将有助于更准确地对 Non-SAH 肝硬化患者进行预后分层。Non-SAH 评分高的患者需要密切监测，可能需要考虑进行预防性肝移植。
ClinicalTrials.gov 标识符：NCT02650011。
