An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study

被引：7

作者：

Dunn, Winston ^{[1
]}

Li, Yanming ^{[1
]}

Singal, Ashwani K. ^{[2
]}

Simonetto, Douglas A. ^{[3
]}

Diaz, Luis A. ^{[4
]}

Idalsoaga, Francisco ^{[4
]}

Ayares, Gustavo ^{[5
]}

Arnold, Jorge ^{[4
]}

Ayala-Valverde, Maria ^{[5
]}

Perez, Diego ^{[5
]}

Gomez, Jaime ^{[5
]}

Escarate, Rodrigo ^{[5
]}

Fuentes-Lopez, Eduardo ^{[6
]}

Ramirez-Cadiz, Carolina ^{[7
,8
]}

Morales-Arraez, Dalia ^{[9
]}

Zhang, Wei ^{[10
,11
]}

Qian, Steve ^{[10
]}

Ahn, Joseph C. ^{[3
]}

Buryska, Seth ^{[3
]}

Mehta, Heer ^{[1
]}

Dunn, Nicholas ^{[1
]}

Waleed, Muhammad ^{[2
]}

Stefanescu, Horia ^{[12
]}

Bumbu, Andreea ^{[12
]}

Horhat, Adelina ^{[13
]}

Attar, Bashar ^{[14
]}

Agrawal, Rohit ^{[15
]}

Cabezas, Joaquin ^{[16
,17
]}

Echavaria, Victor ^{[16
,17
]}

Cuyas, Berta ^{[18
]}

Poca, Maria ^{[18
]}

Soriano, German ^{[18
]}

Sarin, Shiv K. ^{[19
]}

Maiwall, Rakhi ^{[19
]}

Jalal, Prasun K. ^{[20
]}

Higuera-de-la-Tijera, Fatima ^{[21
]}

Kulkarni, Anand V. ^{[22
]}

Rao, P. Nagaraja ^{[22
]}

Guerra-Salazar, Patricia ^{[23
]}

Skladany, Lubomir ^{[24
]}

Kubanek, Natalia ^{[24
]}

Prado, Veronica ^{[25
]}

Clemente-Sanchez, Ana ^{[9
,26
,27
]}

Rincon, Diego ^{[26
]}

Haider, Tehseen ^{[28
]}

Chacko, Kristina R. ^{[28
]}

Romero, Gustavo A. ^{[29
]}

Pollarsky, Florencia D. ^{[29
]}

Restrepo, Juan C. ^{[30
]}

Toro, Luis G. ^{[31
]}

机构：

[1] Univ Kansas, Med Ctr, Dept Gastroenterol, Kansas City, KS USA

[2] Univ Louisville, Dept Gastroenterol & Hepatol, Louisville, KY USA

[3] Dept Med, Div Gastroenterol & Hepatol, Mayo Clin, Rochester, MN USA

[4] Pontificia Univ Catolica Chile, Escuela Med, Dept Gastroenterol, Santiago, Chile

[5] Hosp El Pino, Dept Med, Serv Med Interna, Santiago, Chile

[6] Pontificia Univ Catolica Chile, Fac Med, Dept Hlth Sci, Santiago, Chile

[7] Western Univ, Schulich Sch Med, Dept Anesthesiol & Perioperat Med, Schulich Sch Med & Dent, London, ON, Canada

[8] London Hlth Sci Ctr, London, ON, Canada

[9] Univ Pittsburgh, Ctr Liver Dis, Dept Med, Div Gastroenterol,Med Ctr, Pittsburgh, PA USA

[10] Univ Florida, Dept Med, Div Gastroenterol & Hepatol, Gainesville, FL USA

[11] Columbia Univ, Ctr Liver Dis & Liver Transplantat, Dept Med, New York, NY USA

[12] Reg Inst Gastroenterol & Hepatol, Dept Med, Cluj Napoca, Romania

[13] Univ Med & Pharm Iuliu Hatieganu, Cluj Napoca, Romania

[14] Cook Cty Hlth & Hosp Syst, Dept Med, Div Gastroenterol & Hepatol, Chicago, IL USA

[15] West Virginia Univ, Dept Med, Div Gastroenterol & Hepatol, Morgantown, WV 26506 USA

[16] Univ Hosp Marques Valdecilla, Dept Gastroenterol & Hepatol, Santander, Spain

[17] Res Inst Valdecilla IDIVAL Santander, Clin & Translat Res Digest Dis, Santander, Spain

[18] Univ Autonoma Barcelona, Hosp Sant Creu & Sant Pau, Inst Recerca IIB Sant Pau, Serv Neumol & Alergia,CIBERehd, Barcelona, Spain

[19] Inst Liver & Biliary Sci, Dept Hepatol, New Delhi, India

[20] Baylor Coll Med, Dept Gastroenterol & Hepatol, Houston, TX USA

[21] Univ Nacl Autonoma Mexico, Hosp Gen Mex Dr Eduardo Liceaga, Fac Med, Dept Med,Serv Gastroenterol & Hepatol, Mexico City, Mexico

[22] Asian Inst Gastroenterol, Dept Hepatol, Hyderabad, India

[23] Inst Gastroenterol Boliviano Japones, Cochabamba, Bolivia

[24] Slovak Med Univ, FD Roosevelt Univ Hosp, Dept Internal Med 2, Div Hepatol Gastroenterol & Liver Transplantat, Banska Bystrica, Slovakia

[25] Ctr Hosp Luxembourg, Dept Med, Luxembourg, Luxembourg

[26] Hosp Gen Univ Gregorio Maranon, Dept Digest Dis, Liver Unit, Madrid, Spain

[27] Ciberehd, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[28] Montefiore Med Ctr, Dept Med, Div Gastroenterol & Hepatol, Bronx, NY USA

[29] Hosp Gastroenterol Dr Carlos Bonorino Udaondo, Dept Med, Secc Hepatol, Buenos Aires, Argentina

[30] Univ Antioquia, Hosp Pablo Tobon Uribe, Grp Gastrohepatol, Unidad Hepatol, Medellin, Colombia

[31] Hosp San Vicente Fdn Medellin & Rionegro, Dept Med, Hepatol & Liver Transplant Unit, Rionegro, Colombia

[32] Hosp San Juan Dios, Dept Gastroenterol, Santiago, Chile

[33] Hosp Univ Austral, Dept Med, Hepatol & Liver Transplant Unit, Buenos Aires, Argentina

[34] Hosp Cent San Luis, San Luis, Argentina

[35] Hosp Italiano Buenos Aires, Dept Med, Liver Unit, Buenos Aires, Argentina

[36] Hosp Privado Rosario, Dept Med, Unidad Higado, Rosario, Argentina

[37] Univ Autonoma Barcelona, Vall dHebron Res Inst VHIR, Hosp Univ Vall dHebron, Liver Unit,Dept Med,CIBERehd, Barcelona, Spain

[38] Western Univ, Schulich Sch Med, Dept Med, Div Gastroenterol, London, ON, Canada

[39] Yale Univ, Dept Med, Sect Digest Dis, VA CT Healthcare Syst,Sch Med, New Haven, CT USA

[40] Univ Alberta, Dept Med, Div Gastroenterol, Liver Unit, Edmonton, AB, Canada

[41] Hosp Clin Barcelona, Dept Med, Liver Unit, Barcelona, Spain

[42] Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain

[43] Western Univ, Schulich Sch Med & Dent, Dept Epidemiol & Biostat, London, ON, Canada

[44] Western Univ, Div Gastroenterol & Hepatol, 339 Windermere Rd,Room A10-224, London, ON N6A 5A5, Canada

[45] Univ Hosp, London Hlth Sci Ctr, 339 Windermere Rd,Room A10-224, London, ON N6A 5A5, Canada

[46] Hosp Clin Barcelona, Liver Unit, C Villarroel 170, Barcelona 08036, Spain

来源：

HEPATOLOGY | 2024年 / 80卷 / 05期

关键词：

SHORT-TERM MORTALITY; STAGE LIVER-DISEASE; SCORING SYSTEM; LILLE MODEL; VALIDATION; CORTICOSTEROIDS; PREDNISOLONE; INFECTION; CIRRHOSIS;

D O I：

10.1097/HEP.0000000000000883

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and Aims: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence in a global cohort, we sought to derive and validate an enhanced prognostic model. Approach and Results: The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled patients with AH per National Institute for Alcohol Abuse and Alcoholism criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day postadmission mortality, 3 artificial intelligence algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined through Bayesian updating, integrating the derivation cohort's average 90-day mortality with each center's approximate mortality rate to produce posttest probabilities. The ALCoholic Hepatitis Artificial INtelligence Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30 d) and 27.9% (90 d) in the derivation cohort versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779-0.844) and 0.799 (0.769-0.830), significantly surpassing legacy models like Maddrey's Discriminant Function, Model for End-Stage Liver Disease variations, age-serum bilirubin-international normalized ratio-serum Creatinine score, Glasgow, and modified Glasgow Scores (p < 0.001). ALCoholic Hepatitis Artificial INtelligence Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCoholic Hepatitis Artificial INtelligence Ensemble score > 0.20 in both derivation and validation cohorts. Conclusions: Harnessing artificial intelligence within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.

引用

页码：1196 / 1211

页数：16

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