Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score
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DOI：
10.1136/gut.2004.050781
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发表时间：
2005-08-01
期刊：
影响因子：
24.5
通讯作者：
Morris, AJ
中科院分区：
文献类型：
--
作者：
Forrest, EH;Evans, CDJ;Morris, AJ
酒精性肝炎与高短期死亡率相关。我们的目的是确定那些与死亡率相关的因素，并定义一个简单的评分来预测我们人群的结果。方法：对241例酒精性肝炎患者进行分析。在入院当天（第1天）和第6 - 9天记录临床和实验室数据。采用逐步逻辑回归识别入院后28天和84天的相关变量。这些变量包括在格拉斯哥酒精性肝炎评分（GAHS）及其预测结果的能力评估中。GAHS在195名患者的单独数据集中得到验证。结果：GAHS来源于与结果独立相关的五个变量：年龄（p = 0.001），从第1天的结果来看，血清胆红素（p< 0.001），血尿素（p = 0.019），从第6 - 9天的结果来看，血清胆红素（p< 0.001），凝血酶原时间（p = 0.002）和外周血白细胞计数（p = 0.001）。第1天的GAHS在预测28天预后时的总体准确性为81%。相比之下，修正的判别函数的总体精度为49%。使用6 - 9天的信息和预测84天的结果发现相似的结果。195例患者的验证性研究证实了GAHS的准确性，无论使用国际标准化比率或凝血酶原时间比率，还是酒精性肝炎的诊断是经活检证实或基于临床评估，GAHS都同样准确。结论：使用与死亡率相关的变量，我们推导并验证了一个准确的评分系统来评估酒精性肝炎的预后。该评分能够识别在入院期间死亡风险最大的患者。
Introduction: Alcoholic hepatitis is associated with a high short term mortality. We aimed to identify those factors associated with mortality and define a simple score which would predict outcome in our population.Methods: We identified 241 patients with alcoholic hepatitis. Clinical and laboratory data were recorded on the day of admission ( day 1) and on days 6 - 9. Stepwise logistic regression was used to identify variables related to outcome at 28 days and 84 days after admission. These variables were included in the Glasgow alcoholic hepatitis score (GAHS) and its ability to predict outcome assessed. The GAHS was validated in a separate dataset of 195 patients.Results: The GAHS was derived from five variables independently associated with outcome: age ( p = 0.001) and, from day 1 results, serum bilirubin ( p< 0.001), blood urea ( p = 0.019) and, from day 6 - 9 results, serum bilirubin ( p< 0.001), prothrombin time ( p = 0.002), and peripheral blood white blood cell count ( p = 0.001). The GAHS on day 1 had an overall accuracy of 81% when predicting 28 day outcome. In contrast, the modified discriminant function had an overall accuracy of 49%. Similar results were found using information at 6 - 9 days and when predicting 84 day outcome. The accuracy of the GAHS was confirmed by the validation study of 195 patients The GAHS was equally accurate irrespective of the use of the international normalised ratio or prothrombin time ratio, or if the diagnosis of alcoholic hepatitis was biopsy proven or on the basis of clinical assessment.Conclusions: Using variables associated with mortality we have derived and validated an accurate scoring system to assess outcome in alcoholic hepatitis. This score was able to identify patients at greatest risk of death throughout their admission.