4.7 Article

A New Scoring System for Prognostic Stratification of Patients With Alcoholic Hepatitis

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AMERICAN JOURNAL OF GASTROENTEROLOGY
卷 103, 期 11, 页码 2747-2756

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NATURE PUBLISHING GROUP
DOI: 10.1111/j.1572-0241.2008.02104.x

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资金

  1. Ministerio de Ciencia y Tecnologia
  2. Direccion General de Investigacion [SAF 2005-06245]
  3. Instituto de Salud Carlos III [FIS 05/050567, FIS PI 060085]
  4. Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS)
  5. Fundacion Banco Bilbao Vizcaya Argentaria (FBBVA)

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OBJECTIVES: Prognostic stratification of patients with alcoholic hepatitis (AH) may improve the clinical management and facilitate clinical trials. We aimed at developing a scoring system capable of providing prognostic stratification of patients with AH. METHODS: Patients with biopsy-proven AH were prospectively included between 2000 and 2006. The biochemical, clinical, portal hemodynamic and histological parameters were evaluated. A Cox regression model was used for univariate and multivariate analyses. A predictive score was built using variables obtained at admission identified in the multivariate analysis. The resulting score was validated in an independent prospective cohort. RESULTS: In total, 103 patients with biopsy-proven AH were included in the study cohort. Age, serum bilirubin, serum creatinine, and international normalized ratio (INR) independently predicted 90-day mortality. We generated the Age, serum Bilirubin, INR, and serum Creatinine (ABIC) score: (age x 0.1) + (serum bilirubin x 0.08) + (serum creatinine x 0.3) + (INR x 0.8). The area under the curve (AUC) was 0.82. Using the Kaplan-Meier analysis with the cutoff values of 6.71 and 9.0, we identified patients with low, intermediate, and high risk of death at 90 days (100%, 70%, and 25% of survival rate, respectively). Using the same cutoff values, the ABIC score also stratified patients according to their risk of death at 1 yr. These results were validated by a confirmatory cohort (N = 80). CONCLUSIONS: The ABIC score is a new tool that allows the stratification of risk of death in patients with AH at 90 days and 1 yr. This score can help improve the management of these patients and also help to perform clinical trials.

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