A New Scoring System for Prognostic Stratification of Patients With Alcoholic Hepatitis
A New Scoring System for Prognostic Stratification of Patients With Alcoholic Hepatitis
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DOI：
10.1111/j.1572-0241.2008.02104.x
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发表时间：
2008-11-01
影响因子：
9.8
通讯作者：
Bataller, Ramon
中科院分区：
文献类型：
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作者：
Dominguez, Marlene;Rincon, Diego;Bataller, Ramon
目的：酒精性肝炎（AH）患者的预后分层可以改善临床管理并促进临床试验。我们的目标是开发一个评分系统，能够为AH患者提供预后分层。方法：前瞻性纳入2000年至2006年间活检证实的AH患者。评估生化、临床、门静脉血流动力学和组织学参数。采用Cox回归模型进行单因素和多因素分析。使用在多变量分析中确定的入院时获得的变量建立预测评分。结果得分在一个独立的前瞻性队列中得到验证。结果：共有103例活检证实的AH患者被纳入研究队列。年龄、血清胆红素、血清肌酐和国际标准化比值（INR）独立预测90天死亡率。我们生成年龄、血清胆红素、INR和血清肌酐（ABIC）评分：（年龄× 0.1） +（血清胆红素× 0.08） +（血清肌酐× 0.3） + （INR × 0.8）。曲线下面积（AUC）为0.82。使用Kaplan-Meier分析（截止值为6.71和9.0），我们确定了90天低、中、高死亡风险患者（分别为100%、70%和25%的生存率）。使用相同的截止值，ABIC评分也根据1年死亡风险对患者进行分层。这些结果通过验证性队列（N = 80）得到验证。结论：ABIC评分是一种新的工具，可以对AH患者在90天和1年的死亡风险进行分层。该评分有助于改善对这些患者的管理，也有助于进行临床试验。
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.