Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 7, 2006; 12(25): 4020-4025
Published online Jul 7, 2006. doi: 10.3748/wjg.v12.i25.4020
Predicting utility of a model for end stage liver disease in alcoholic liver disease
Aspasia S Soultati, Spyridon P Dourakis, Alexandra Alexopoulou, Melanie Deutsch, Larissa Vasilieva, Athanasios J Archimandritis
Aspasia S Soultati, Spyridon P Dourakis, Alexandra Alexopoulou, Melanie Deutsch, Larissa Vasilieva, Athanasios J Archimandritis, 2nd Department of Internal Medicine, University of Athens Medical School, Hippokration General Hospital, 114 Vas Sofias Avenues, Athens 11527, Greece
Co-first-author: Aspasia S Soultati
Correspondence to: Spyridon P Dourakis, 28 Achaias st, Athens 11523, Greece. spdour@med.uoa.gr
Telephone: +30-210-6918464 Fax: +30-210-6993693
Received: November 1, 2005
Revised: December 15, 2006
Accepted: December 26, 2006
Published online: July 7, 2006
Abstract

AIM: To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term (30 d and 90 d) mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis.

METHODS: Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted.

RESULTS: 30- and 90-d mortality rates were reported at 5.9% (2/34) and 14.7% (5/34), respectively. Significant correlation was demonstrated for the Model for End-Stage Liver Disease (P30 = 0.094, P90 = 0.046) and the Maddrey Discriminant Function score (P30 = 0.033, P90 = 0.038) with 30- and 90-d mortality whereas a significant association was also established for alanine aminotransferase (P = 0.057), fibrin degradation products (P = 0.048) and C-reactive protein (P = 0.067) with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 (95%CI: 0.902-1.036, P = 0.028) for the Model for End-Stage Liver Disease score and 0.984 (95%CI: 0.942-1.027, P = 0.023) for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 (sensitivity 1, specificity 0.937) and 108.68 (sensitivity 1, specificity 0.969), respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 (95%CI: 0.559-0.965, P = 0.065) for the Model for End-Stage Liver Disease score and 0.752 (95%CI: 0.465-1.038, P = 0.076) for the Maddrey Discriminant Function score with the optimal cut off point of 19 (sensitivity 0.6, specificity 0.6) and 92 (sensitivity 0.6, specificity 0.946), respectively. The observed Kaplan Meier survival rates for different score-categories were compared with log-rank tests and higher score values were correlated with a lower survival.

CONCLUSION: Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotransferase as independent predictors of 90-d mortality has also been verified.

Keywords: Alcoholic liver disease; Alcoholic hepatitis; Maddrey discriminant function score; Model for end-stage liver disease score