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PLoS One. 2014;9(7):e100870.

Spontaneous evolution in bilirubin levels predicts liver-related mortality in patients with alcoholic hepatitis.

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제1저자 이민종 · 교신저자 김원

소속 (5)
  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  2. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
  3. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
  4. Department of Internal Medicine, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.
  5. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.

Abstract

The accurate prognostic stratification of alcoholic hepatitis (AH) is essential for individualized therapeutic decisions. The aim of this study was to develop a new prognostic model to predict liver-related mortality in Asian AH patients. We conducted a hospital-based, retrospective cohort study using 308 patients with AH between 1999 and 2011 (a derivation cohort) and 106 patients with AH between 2005 and 2012 (a validation cohort). The Cox proportional hazards model was constructed to select significant predictors of liver-related death from the derivation cohort. A new prognostic model was internally validated using a bootstrap sampling method. The discriminative performance of this new model was compared with those of other prognostic models using a concordance index in the validation cohort. Bilirubin, prothrombin time, creatinine, potassium at admission, and a spontaneous change in bilirubin levels from day 0 to day 7 (SCBL) were incorporated into a model for AH to grade the severity in an Asian patient cohort (MAGIC). For risk stratification, four risk groups were identified with cutoff scores of 29, 37, and 46 based on the different survival probabilities (P<0.001). In addition, MAGIC showed better discriminative performance for liver-related mortality than any other scoring system in the validation cohort. MAGIC can accurately predict liver-related mortality in Asian patients hospitalized for AH. Therefore, SCBL may help us decide whether patients with AH urgently require corticosteroid treatment.

Figures

Figure 1
Figure 1 Flow charts for the derivation cohort (A) and the validation cohort (B).
Figure 2
Figure 2 Risk stratification of liver-related death according to the cumulative survival probabilities in the derivation cohort. We analyzed survival data using conditional inference trees to stratify a derivation cohort into four risk groups and to determine the optimal cutoff scores of MAGIC. The X-axis indicates the survival time (days), and the Y-axis indicates the survival probability (%). MAGIC, model for alcoholic hepatitis to grade the severity in an Asian patient cohort.
Figure 3
Figure 3 Validation of the optimal cutoff scores of MAGIC for individual risk groups of liver-related death in the validation cohort. The X-axis indicates the survival time (days), and the Y-axis indicates the survival probability (%). The solid line represents the mild-risk group (≤29, n = 42), the dashed line represents the moderate-risk group (29<risk score≤37, n = 26), the large dotted line represents the severe-risk group (37<risk score≤46, n = 20), and the small dotted line represents the very severe-risk group (>46, n = 18). MAGIC, model for alcoholic hepatitis to grade the severity in an Asian patient cohort.

그림 출처: PubMed Central 공개 논문 (PMC4094461)

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Conflict of interest statement

Competing Interests:The authors have declared that no competing interests exist.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
PloS one · eISSN 1932-6203
전자 출판
2014-07-11
MeSH
Adult · Bilirubin / blood · Cohort Studies · Creatinine / blood · Female · Hepatitis, Alcoholic / blood / mortality / pathology · Humans · Male · Middle Aged · Potassium / blood · Prognosis · Prothrombin Time · Retrospective Studies
Substances
Creatinine · Bilirubin · Potassium
참고문헌
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