Comparison Between Dynamic Models for Predicting Response to Corticosteroids in Alcohol-Associated Hepatitis: A Global Cohort Study

Abstract

Several dynamic models predict mortality and corticosteroid response in alcohol-associated hepatitis (AH), yet no consensus exists on the most effective model. This study aimed to assess predictive models for corticosteroid response and short-term mortality in severe AH within a global cohort. We conducted a multi-national study of patients with severe AH treated with corticosteroids for at least 7 days, enrolled between 2009 and 2019. Dynamic models-Lille-4, Lille-7, trajectory of serum bilirubin (TSB), and neutrophil-to-lymphocyte ratio (NLR)-were used to estimate 30- and 90-day mortality. Lille-7 demonstrated the highest accuracy for both 30- and 90-day mortality.

Keywords: alcohol; alcoholic cirrhosis; alcohol‐associated liver disease; alcohol‐related hepatitis; cirrhosis; end‐stage liver disease; outcome prediction.

FIGURE 1

ROC curves of risk scores to predict mortality by 30 days and 90 days. The figure displays the performance of different risk scores in predicting mortality, with panel (A) representing the 30‐day mortality predictions and panel (B) illustrating the 90‐day mortality predictions. Lille‐4, Lille at day 4; Lille‐7, Lille at day 7; NLR, delta neutrophil‐to‐lymphocyte ratio; TSB, trajectory serum bilirubin.