Prognostic and diagnostic scoring models in acute alcohol-associated hepatitis: A review comparing the performance of different scoring systems

Table 3 Alcohol-associated hepatitis prognostic scores advantages and limitations

Clinical score	Components	Advantages	Limitations
MELD	INR, bilirubin (total), creatinine, sodium	MELD or MELD-Na ≥ 20 predicts high mortality at 30 d, consider corticosteroid therapy	(1) Mortality overestimation with elevated creatinine levels; (2) interpersonal variability of creatinine levels; (3) extrahepatic causes of sodium fluctuations; and (4) does not account for markers of AAH complications other than kidney and liver failure
Maddrey discriminant function	PT (measured and control), bilirubin (total)	MDF ≥ 32 predicts high mortality at 30 d, consider corticosteroid therapy. Oldest, most commonly used score	(1) AKI and other AAH complications not reflected in MDF; (2) PT use instead of INR; and (3) low specificity
GAHS	Age, WBC, BUN, bilirubin, PT (measured and control)	GAHS ≥ 9 is in favor of high mortality, helpful for selecting candidates for steroid treatment	(1) Only studied on the British population; and (2) lower sensitivity for short-term mortality compared to MELD/MDF
ABIC	Age, Bilirubin, INR, PT (measured and control)	Score < 6.71 has high negative predictive value to detect patients with low risk	(1) Not used for deciding on steroid initiation; and (2) low accuracy for predicting mortality in severe group
Lille score	Age, bilirubin (initial, and day 4 OR day 7), albumin, creatinine, and PT	Lille score ≤ 0.45 at day 7 (or 4) implies good response to corticosteroids	(1) Complex to calculate; (2) uses PT instead of INR; and (3) bias secondary to elevated creatinine levels and interpersonal variability of creatinine
Alcoholic hepatitis histological score	Histologic features of liver injury	Can be combined with clinical prognostic scores for more accurate mortality risk stratification	(1) Requires liver biopsy (invasive); and (2) static

MELD: Model for end-stage liver disease; INR: International normalized ratio; BUN: Blood urea nitrogen; AKI: Acute kidney injury; WBC: White blood cells; MDF: Maddrey discriminant function; AAH: Alcohol-associated hepatitis; PT: Prothrombin time; GAHS: Glasgow alcoholic hepatitis score; ABIC: Age-bilirubin-INR-creatinine score.