The utility of scoring systems in predicting early and late mortality in alcoholic hepatitis: whose score is it anyway?

Naaventhan Palaniyappan, Venkataraman Subramanian, Vidyasagar Ramappa, Stephen D Ryder, Philip Kaye, Guruprasad P Aithal
International Journal of Hepatology 2012, 2012: 624675
Background. Alcoholic hepatitis (AH) is a distinct clinical entity in the spectrum of alcoholic liver disease with a high short-term mortality. Several scoring systems are being used to assess the severity of AH but the ability of these scores to predict long-term survival in these patients is largely unknown. Aims. We aim to assess the utility of five different scoring systems Child Pugh (CP), model for end-stage liver disease (MELD), Maddrey's discriminant function (mDF), Glasgow AH score (GAHS), and age-bilirubin-INR-creatinine (ABIC) score in predicting shot-term and long-term survival in patients with AH. Methods. Patients with histological evidence of AH were identified from our database. The clinical and biochemical parameters were used to calculate the 5 different scores. The prognostic utility of these scores was determined by generating an ROC curve for survival at 30 days, 90 days, 6 months, and 1 year. Results and Conclusions. All 5 scores with the exception of CP score have a similar accuracy in predicting the short-term prognosis. However, they are uniformly poor in predicting longer-term survival with AUROC not exceeding 0.74. CP score is a very poor predictor of survival in both short and long term. Abstinence from alcohol was significantly (P < 0.05) associated with survival at 1 year.

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