New prognostic model accurately predicts 30-day mortality in alcohol-associated hepatitis
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A new prognostic scoring tool accurately assessed 30-day mortality risk in patients with alcohol-associated hepatitis, according to a study published in Mayo Clinic Proceedings.
“Prognostic modeling is becoming increasingly intertwined into an emerging yet controversial topic in the field of hepatology, including whether patients with severe [alcohol-associated hepatitis (AH)] should receive early liver transplants,” Camille A. Kezer, MD, of the department of internal medicine at the Mayo Clinic, and colleagues wrote. “This clinical and ethical predicament highlights why a prognostic model with the strongest possible correlation for short-term mortality should be sought after.”
Seeking to create such a model, Kezer and colleagues identified a cohort of 266 patients with AH from January 1998 to December 2018 from a single care center. They used multivariate logistic regression to develop a new scoring system, the Mortality Index for Alcohol-Associated Hepatitis (MIAAH), that could predict 30-day mortality. The MIAAH is comprised of laboratory variables and demographic data.
Investigators found that the 30-day mortality rate in this cohort was 19.2%. Among the variables correlated with mortality on multivariate analysis were age (P = .002), blood urea nitrogen (P = .003), albumin (P = .01), bilirubin (P = .02) and international normalized ratio (P = .001).
According to study results, the MIAAH achieved a C statistic of 0.86, which was significantly higher than existing prognostic models, including the Model for End-Stage Liver Disease (MELD) and the Maddrey Discriminant Function (MDF).
Comparatively, in a validation cohort of 249 patients from two external care centers, the C statistic for MIAAH decreased to 0.73 but remained superior to the MDF (P = .01). It was not deemed more accurate than the MELD.
“At a minimum, the MIAAH does compete with the MELD and outperformed the MDF, which remains commonly used in clinic practice despite its less than desirable performance characteristics,” Kezer and colleagues concluded. “Furthermore, this study finds that optimum prognostication will likely require a combination of prognostic models or the addition of novel variables, such as biomarkers.
“Whereas we anticipate that the MIAAH will continue to be refined over time, perhaps with the addition of a dynamic component or in conjunction with an existing model such as the MELD, this study finds that it is a novel and useful tool in assessing 30-day mortality risk in patients with AH.”
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