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New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey’s discriminant function <32

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Abstract

Background & aims

Few studies have investigated the prognosis of patients with non-severe alcoholic hepatitis (Non-SAH). The study aimed to develop a new prognostic model for patients with especially Non-SAH.

Methods

We extracted 316 hospitalized patients with alcoholic cirrhosis without severe alcoholic hepatitis, defined as Maddrey’s discriminant function score lower than 32, from the retrospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort to develop a new prognostic model (training set), and validated it in 419 patients from the prospective KACLiF cohort (validation set). Prognostic factors for death and liver transplantation were analyzed to construct a prognostic model.

Results

Twenty-one and 24 patients died within 6 months in both sets, respectively. In the training set, the highest area under the curve (AUC) of conventional prognostic models was 0.765, 0.732, and 0.684 for 1-, 3-, and 6-month mortality, respectively. Refractory ascites, vasopressor use, and hyponatremia were independently associated with mortality of cirrhotic patients with Non-SAH. The new model consisted of four variables: past deterioration, neutrophil proportion > 70%, Na < 128 mmol/L, and vasopressor use. It showed the highest accuracy for short-term mortality in the training and validation sets (0.803 and 0.786; 0.797 and 0.776; and 0.789 and 0.721 for 1-, 3-, and 6-month mortality, respectively).

Conclusion

There is a group of patients with high risk among those classified as Non-SAH. The new model will help stratifying cirrhotic patients with Non-SAH more accurately in terms of prognosis. The patients with high Non-SAH score need to monitor closely and might be considered for preemptive liver transplantation.

Trial regestration

ClinicalTrials.gov identifier: NCT02650011.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due personal medical records, but are available from the corresponding author on reasonable request and approval of IRB.

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Acknowledgments

We thank the Collaborators of the Korean Acute-on-Chronic Liver Failure (KACLiF) study group, and Editage (www.editage.co.kr) for English language editing.

Funding

This work was supported partly by Korea University Research Grants (No. K2119231) and partly by Basic Science Research Program (National Research Foundation of Korea), No. 2020R1A6A1A03043026.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea

    Tae Hyung Kim, Hyung Joon Yim, Young Kul Jung & Seong Hee Kang

  2. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea

    Tae Hyung Kim, Ji Won Park & Sung-Eun Kim

  3. Department of Internal medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea

    Do Seon Song & Jin Mo Yang

  4. Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea

    Eileen L. Yoon

  5. Department of Internal medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea

    Hee Yeon Kim

  6. Department of Internal medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea

    Hee Yeon Kim & Sung Won Lee

  7. Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea

    Seong Hee Kang & Moon Young Kim

  8. Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea

    Young Chang, Soung Won Jeong & Jae Young Jang

  9. Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

    Jeong-Ju Yoo & Sang Gyune Kim

  10. Department of Internal Medicine, Ulsan University Gangneung Asan Hospital, Gangneung, Korea

    Baek Gyu Jun

  11. Department of Internal Medicine, Asan Seoul Internal Medicine Clinic, Seoul, Korea

    Baek Gyu Jun

  12. Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea

    Jung Gil Park

  13. Department of Internal Medicine, New Hope Internal Medicine Clinic Seoul, Seoul, Korea

    Tae Yeob Kim

  14. Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, 24253, Gangwon-do, Korea

    Ki Tae Suk & Dong Joon Kim

  15. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

    Won Kim

Authors
  1. Tae Hyung Kim
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Consortia

The Korean Acute-on-Chronic Liver Failure (KACLiF) Study Group

Contributions

Study conception and design: Yim HJ, Kim DJ; Acquisition of data: Yoon EL, Kang SH, Kim HY, Chang Y, Lee SW, Yoo JJ, Baek GJ, Park JK, Kim TY, Song DS, Park JW, Kim SE, Jeong SW, Suk KT, Jung YK, Kim MY, Kim SG, Jang JY, Kim W and Yang JM.; Data analysis and interpretation: Kim TH and Yim HJ.; Draft writing: Kim TH.; Review and final approval of the submission of the manuscript: Yim HJ, Jang JY and Kim DJ.

Corresponding authors

Correspondence to Hyung Joon Yim or Dong Joon Kim.

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Conflict of interest

The authors Tae Hyung Kim, Hyung Joon Yim, Young Kul Jung, Do Seon Song, Eileen L. Yoon, Hee Yeon Kim, Seong Hee Kang, Young Chang, Jeong-Ju Yoo, Baek Gyu Jun, Sung Won Lee, Jung Gil Park, Ji Won Park, Sung-Eun Kim, Tae Yeob Kim, Soung Won Jeong, Ki Tae Suk, Moon Young Kim, Sang Gyune Kim, Won Kim, Jae Young Jang, Jin Mo Yang, Dong Joon Kim have no relevant financial or non-financial interests to disclose.

Ethical approval

The present study was approved by the institutional review board of each participating center (approval nos. 2014AS0123 and 2015AS0090 from the center of the corresponding author). All authors had access to the study data and had reviewed and approved the final manuscript.

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Kim, T.H., Yim, H.J., Jung, Y.K. et al. New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey’s discriminant function <32. Hepatol Int 18, 500–508 (2024). https://doi.org/10.1007/s12072-023-10582-1

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