Alkaline phosphatase: the next independent predictor of the poor 90-day outcome in alcoholic hepatitis

Biomed Res Int. 2013;2013:614081. doi: 10.1155/2013/614081. Epub 2013 Sep 17.

Abstract

Aim: Determination of risk factors relevant to 90-day prognosis in AH. Comparison of the conventional prognostic models such as Maddrey's modified discriminant function (mDF) and Child-Pugh-Turcotte (CPT) score with newer ones: the Glasgow Alcoholic Hepatitis Score (GAHS); Age, Bilirubin, INR, Creatinine (ABIC) score, Model for End-Stage Liver Disease (MELD), and MELD-Na in the death prediction.

Patients and methods: The clinical and laboratory variables obtained at admission were assessed. The mDF, CPT, GAHS, ABIC, MELD, and MELD-Na scores' different areas under the curve (AUCs) and the best threshold values were compared. Logistic regression was used to assess predictors of the 90-day outcome.

Results: One hundred sixteen pts fulfilled the inclusion criteria. Twenty (17.4%) pts died and one underwent orthotopic liver transplantation (OLT) within 90 days of follow-up. No statistically significant differences in the models' performances were found. Multivariate logistic regression identified CPT score, alkaline phosphatase (AP) level higher than 1.5 times the upper limit of normal (ULN), and corticosteroids (CS) nonresponse as independent predictors of mortality.

Conclusions: The CPT score, AP > 1.5 ULN, and the CS nonresponse had an independent impact on the 90-day survival in AH. Accuracy of all studied scoring systems was comparable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / metabolism
  • Adult
  • Aged
  • Alkaline Phosphatase / blood
  • Alkaline Phosphatase / metabolism*
  • Female
  • Hepatitis, Alcoholic / mortality
  • Hepatitis, Alcoholic / pathology*
  • Humans
  • Liver Transplantation
  • Logistic Models
  • Male
  • Middle Aged
  • Prognosis*
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index
  • Survival Analysis

Substances

  • Adrenal Cortex Hormones
  • Alkaline Phosphatase