Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis
Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis
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DOI：
10.1016/j.jhep.2017.11.017
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发表时间：
2018-03-01
影响因子：
25.7
通讯作者：
Allison, Michael
中科院分区：
文献类型：
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作者：
Forrest, Ewan H.;Atkinson, Stephen R.;Allison, Michael
背景和目的：酒精性肝炎的“静态”预后模型使用单个时间点的数据，包括判别函数（DF）、格拉斯哥酒精性肝炎评分（GAHS）、年龄、血清胆红素、国际标准化比值和血清肌酐（ABIC）评分以及终末期肝病模型（MELD）。 “动态”评分结合了 7 天胆红素的变化，包括里尔评分。本研究的目的是评估这些评分在 STOPAH 试验患者中的表现。方法：通过受试者工作曲线下面积 (AUC) 评估评分的预测表现。通过 Kaplan-Meier 分析评估不同治疗策略对生存的影响，并使用对数秩检验进行测试。结果：总共研究了 1,068 名患者。对于 28 天和 90 天的结果，DF 的 AUC 显着低于 MELD、ABIC 和 GAHS：90 天的值分别为 0.670、0.704、0.726 和 0.713。第 7 天的“动态”分数和“静态”分数变化具有相似的 AUC。 “静态”评分持续较低的患者 28 天死亡率较低，泼尼松龙并未改善这种情况（MELD < 25：8.6%；ABIC < 6.71：6.6%；GAHS < 9：5.9%）。在没有胃肠道出血或败血症的高“静态”评分患者中，泼尼松龙降低了 28 天死亡率（MELD：22.2% vs. 28.9%，p = 0.13；ABIC 14.6% vs. 21%，p = 0.02；GAHS 21% vs. 29.3%，p = 0.04）。治疗所有 DF = 32 和里尔评估的患者的总死亡率（90 天死亡率 26.8%）高于新的“静态”和“动态”评分的组合（90 天死亡率：MELD/里尔 21.8%；ABIC/里尔 23.7%；GAHS/里尔 20.6%）。结论：MELD、ABIC 和 GAHS 在酒精性肝炎方面优于 DF。持续的低分具有良好的结果，但泼尼松龙并未改善。基线静态评分和第 7 天评分相结合，减少了接触皮质类固醇的患者数量，并改善了 90 天的结果。皇冠版权所有 (C) 2017 由 Elsevier B.V. 代表欧洲肝脏研究协会出版。版权所有。
Background & Aims: 'Static' prognostic models in alcoholic hepatitis, using data from a single time point, include the discriminant function (DF), Glasgow alcoholic hepatitis score (GAHS), the age, serum bilirubin, international normalized ratio and serum creatinine (ABIC) score and the model of end-stage liver disease (MELD). 'Dynamic' scores, incorporating evolution of bilirubin at seven days, include the Lille score. The aim of this study was to assess these scores' performance in patients from the STOPAH trial.Methods: Predictive performance of scores was assessed by area under the receiver operating curve (AUC). The effect of different therapeutic strategies upon survival was assessed by Kaplan-Meier analysis and tested using the log-rank test.Results: A total of 1,068 patients were studied. The AUCs for the DF were significantly lower than for MELD, ABIC and GAHS for both 28-and 90-day outcomes: 90-day values were 0.670, 0.704, 0.726 and 0.713, respectively. 'Dynamic' scores and change in 'static' scores by Day 7 had similar AUCs. Patients with consistently low 'static' scores had low 28-day mortalities that were not improved with prednisolone (MELD < 25: 8.6%; ABIC < 6.71: 6.6%; GAHS < 9: 5.9%). In patients with high 'static' scores without gastrointestinal bleeding or sepsis, prednisolone reduced 28-day mortality (MELD: 22.2% vs. 28.9%, p = 0.13; ABIC 14.6% vs. 21%, p = 0.02; GAHS 21% vs. 29.3%, p = 0.04). Overall mortality from treating all patients with a DF = 32 and Lille assessment (90-day mortality 26.8%) was greater than combining newer 'static' and 'dynamic' scores (90-day mortality: MELD/Lille 21.8%; ABIC/Lille 23.7%; GAHS/Lille 20.6%).Conclusion: MELD, ABIC and GAHS are superior to the DF in alcoholic hepatitis. Consistently low scores have a favourable outcome not improved with prednisolone. Combined baseline static' and Day 7 scores reduce the number of patients exposed to corticosteroids and improve 90-day outcome. Crown Copyright (C) 2017 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. All rights reserved.