P2825 - Predictive Performance of Age and Initial Serum Albumin Compared to Traditional Prognostic Scores in Alcohol-Associated Hepatitis

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

LV

Laura M. Vance, DO

Creighton University Medical Center
Omaha, NE, United States

Laura M. Vance, DO¹, Natalie J. Moore, BS¹, Ryan Walters, PhD², Subhash Chandra, MBBS³
¹Creighton University Medical Center, Omaha, NE; ²Creighton University School of Medicine, Omaha, NE; ³Creighton University, Omaha, NE

Introduction: Multiple laboratory based prognostic scores are recommended in clinical practice guidelines for risk stratification and prognosis in alcohol associated hepatitis (AAH). None of these are very accurate and use of a combination of them is recommended in clinical practice. In our clinical experience, we noted older age and low initial serum albumin as important predictors of poor outcomes in AAH. In this study, we compared predictive performance of age and initial serum albumin for 30-day mortality against Maddrey discriminant function (DF), Model for End-Stage Liver Disease Sodium (MELD-Na) and Age, serum Bilirubin, INR and serum Creatinine (ABIC) score.

Methods: Consecutive adult admissions between January 2016 to December 2020 for symptomatic AAH (defined by alcohol use, evidence of liver injury and total bilirubin >3mg/dL) to our one academic and two community hospitals, located in a Midwestern USA metropolitan area, were included. DF, MELD-Na and ABIC prognostic scores were calculated from admission lab values. Primary outcome was 30-day mortality. Predictive performance was compared using area under the receiver operator curve (AUROC). Severe AAH was based on admission DF >32 or MELD-Na >20.

Results: A total of 309 patients were admitted with AAH during the study period, median age 46 (IQR: 38-46) years, 195 (63.1%) males, 250 (80.9%) patients were Caucasians and median BMI was 27.8 (IQR: 23.9-32.3). Overall, 30-day mortality was observed in 55 patients (17.8%). 54 (21.8%) of 248 patients were severe AAH. As shown in Table 1 and Figure 1, AUROC for age alone was 0.65 (0.57-0.73), comparable to DF (p = 0.707) but marginally lower than MELD-NA (p= 0.048). The AUROC for serum albumin was 0.71 (0.63-0.78), comparable to DF (p=0.525), MELD_NA (p=0.319) and ABIC score (p=0.423). Adding age and serum albumin to DF improved predictive performance significantly, p = 0.045.

Discussion: Easily available age and serum albumin level carry important prognostic value and their addition to DF improve its prognostic performance significantly. These findings need to be validated in an external cohort before being used in clinical practice with confidence.

Figure: AUROC curve for each predictive model.

			Comparison Model, p-values
Model	Variables	AUROC (95% CI)	1	2	3	4	5	6	7	8	9
1	Alb + Age	0.75 (0.68 - 0.82)	-
2	Alb + Age + DF	0.77 (0.71 - 0.84)	0.643	-
3	Alb + Age + MELD-Na	0.81 (0.75 - 0.87)	0.192	0.395	-
4	Alb + ABIC	0.72 (0.64 - 0.77)	0.488	0.241	0.041	-
5	Alb	0.71 (0.63 - 0.78)	0.394	0.183	0.028	0.868	-
6	Age	0.65 (0.57 - 0.73)	0.067	0.020	0.001	0.246	0.323	-
7	DF	0.67 (0.60 - 0.75)	0.132	0.045	0.004	0.418	0.525	0.707	-
8	MELD-Na	0.76 (0.69 - 0.83)	0.888	0.748	0.244	0.402	0.319	0.048	0.098	-
9	ABIC	0.75 (0.58 - 0.82)	0.964	0.614	0.181	0.520	0.423	0.076	0.147	0.854	-

Table: Area under receiver operator curve (AUROC) to compare predictive performance of age, serum albumin with DF, MELD-Na and ABIC score.

Disclosures:

Laura Vance indicated no relevant financial relationships.

Natalie Moore indicated no relevant financial relationships.

Ryan Walters indicated no relevant financial relationships.

Subhash Chandra indicated no relevant financial relationships.

Laura M. Vance, DO¹, Natalie J. Moore, BS¹, Ryan Walters, PhD², Subhash Chandra, MBBS³. P2825 - Predictive Performance of Age and Initial Serum Albumin Compared to Traditional Prognostic Scores in Alcohol-Associated Hepatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.