Mitri J, Almeqdadi M, Karagozian R. Prognostic and diagnostic scoring models in acute alcohol-associated hepatitis: A review comparing the performance of different scoring systems. World J Hepatol 2023; 15(8): 954-963 [PMID: 37701919 DOI: 10.4254/wjh.v15.i8.954]
Corresponding Author of This Article
Raffi Karagozian, MD, Assistant Professor, Division of Gastroenterology & Hepatology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States. raffi.karagozian@tuftsmedicine.org
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2023; 15(8): 954-963 Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.954
Prognostic and diagnostic scoring models in acute alcohol-associated hepatitis: A review comparing the performance of different scoring systems
Jad Mitri, Mohammad Almeqdadi, Raffi Karagozian
Jad Mitri, Department of Medicine, Saint Elizabeth’s Medical Center, Boston, MA 02135, United States
Mohammad Almeqdadi, Division of Transplant and Hepatobiliary Disease, Tufts Medical Center, Boston, MA 02111, United States
Raffi Karagozian, Division of Gastroenterology & Hepatology, Tufts Medical Center, Boston, MA 02111, United States
Author contributions: Mitri J and Almeqdadi M reviewed the literature, planned the outline, and created the tables and figure; Mitri J wrote the manuscript with contributions and supervision from Almeqdadi M and Karagozian R; Almeqdadi M and Karagozian R proofread the manuscript; Almeqdadi M designed figure 1; Mitri J, Almeqdadi M, and Karagozian R revised the manuscript and wrote the comments to reviewers.
Conflict-of-interest statement: The authors declare that there was no conflict of interest regarding the publication of this mini-review.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raffi Karagozian, MD, Assistant Professor, Division of Gastroenterology & Hepatology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States. raffi.karagozian@tuftsmedicine.org
Received: May 4, 2023 Peer-review started: May 4, 2023 First decision: May 27, 2023 Revised: June 24, 2023 Accepted: July 25, 2023 Article in press: July 25, 2023 Published online: August 27, 2023
Abstract
Alcohol-associated hepatitis (AAH) is a severe form of liver disease caused by alcohol consumption. In the absence of confounding factors, clinical features and laboratory markers are sufficient to diagnose AAH, rule out alternative causes of liver injury and assess disease severity. Due to the elevated mortality of AAH, assessing the prognosis is a radical step in management. The Maddrey discriminant function (MDF) is the first established clinical prognostic score for AAH and was commonly used in the earliest AAH clinical trials. A MDF > 32 indicates a poor prognosis and a potential benefit of initiating corticosteroids. The model for end stage liver disease (MELD) score has been studied for AAH prognostication and new evidence suggests MELD may predict mortality more accurately than MDF. The Lille score is usually combined to MDF or MELD score after corticosteroid initiation and offers the advantage of assessing response to treatment a 4-7 d into the course. Other commonly used scores include the Glasgow Alcoholic Hepatitis Score and the Age Bilirubin international normalized ratio Creatinine model. Clinical AAH correlate adequately with histologic severity scores and leave little indication for liver biopsy in assessing AAH prognosis. AAH presenting as acute on chronic liver failure (ACLF) is so far prognosticated with ACLF-specific scoring systems. New artificial intelligence-generated prognostic models have emerged and are being studied for use in AAH. Acute kidney injury (AKI) is one possible complication of AAH and is significantly associated with increased AAH mortality. Predicting AKI and alcohol relapse are important steps in the management of AAH. The aim of this review is to discuss the performance and limitations of different scoring models for AAH mortality, emphasize the most useful tools in prognostication and review predictors of recurrence.
Core Tip: Clinical prognostic scores for alcohol-associated hepatitis (AAH) are reliable and commonly minimize the need for histological assessment. Model for end stage liver disease (MELD) score is recently showing superiority compared to the commonly used Maddrey Discriminant function for AAH prognostication. Combining MELD at diagnosis with day 4 (or day 7) Lille score when managing severe AAH would be interesting to validate as a superior mean of assessing AAH prognosis. Acute kidney injury is a complication of AAH with significant impact on mortality. It is therefore important to account for when managing AAH.
