Maddrey Discriminant Function as modified by Carithers et al (DF)
DF = 4.6 [prothrombin time (seconds) – control] + bilirubin (mg/dL)
INR Discriminant Function (INRdf)
INRdf = 24 x (INR – 1) + bilirubin (mg/dL)
Supplementary Figure A:Comparison of PT Results Before and After Reagent Change
Model of End-stage Liver Disease (MELD) with United Network for Organ Sharing modification
MELD = [9.57X loge (creatinine mg/dL, minimum = 1, maximum = 4)] + [3.78 x loge (bilirubin mg/dL, minimum = 1, maximum = 4)] + [11.2 x loge (INR, minimum =1)] + 6.43
ABIC score
ABIC = (age x 0.1) + (serum bilirubin x 0.08) + (INR x 0.8) + (serum creatinine x 0.3)
Glasgow alcoholic hepatitis score = GAHS (including conversion of urea in mg/dL and bilirubin in mg/dL to SI units)
Score given
1 / 2 / 3
Age / < 50 / ≥ 50 / -
WCC (109/L) / < 15 / ≥ 15 / -
Urea (mg/dL) / (5/0.357) 14 / ≥ 5 / -
PT (INR) ratio / < 1.5 / 1.2 – 2.0 / > 2.0
Bilirubin (mg/dL) / (125/17.1) 7.3 / 125 – 250 / (250/17.1) 14.6
Supplementary Figure B: Correlation between DF and MELD measures of severity on admission
A.B.
C.
Supplementary Table B: Initial and Peak Laboratory Values during Admission
Totaln = 148 / INRdf < 50
n = 115 / INRdf >50
n = 33 / p value*†
Bilirubin mg/dL
Initial mean ± SD
median, (range)
Peak mean ± SD
median, (range)
Increased after admit / 14.1 ± 9.7
10.2 (2.4 – 46.6)
17.6 ± 11.8
14 (5.1 – 64.4)
74/148 (50%) / 11.3 ± 7.3
8.2 (2.4 – 33.1)
14.7 ± 9.8
10.5 (5.1 – 45.8)
50/115 (43%) / 23.8 ± 10.7
23.8 (5.4 – 46.6)
27.9 ± 12.6
24.8 (6.6 – 64.4)
24/33 (73%) / < 0.0001
< 0.0001
0.003*
PT seconds
Initial mean ± SD
median, (range)
Peak mean ± SD
median, (range)
Increased after admit / 18.7 ± 6.7
17.1 (10.4 – 51.5)
21.3 ± 12.5
18.4 (10.4 – 137)
76/148 (51%) / 16.2 ± 2.9
16.0 (10.4 – 23.6)
19.1 ± 12.7
17.1 (10.4 – 137)
60/115 (52%) / 27.5 ± 8.6
26.0 (15.7 – 51.5)
29.0 ± 8.4
27.6 (15.7 – 51.5)
15/33 (45%) / < 0.0001
< 0.0001
0.50*
INR units
Initial mean ± SD
median, (range)
Peak mean ± SD
median, (range)
Increased after admit / 1.9 ± 0.7
1.7 (0.9 – 5.4)
2.1 ± 0.9
1.9 (0.9 – 6.1)
60/148 (41%) / 1.6 ± 0.3
1.6 (0.9 – 2.5)
1.8 ± 0.7
1.7 (0.9 – 6.1)
46/115 (40%) / 2.9 ± 0.9
2.7 (1.6 – 5.4)
3.0 ± 0.9
2.8 (1.6 – 5.4)
14/33 (42%) / < 0.0001
< 0.0001
0.72*
Supplementary Table B: Initial and Peak Laboratory Values during Admission (continued)
Totaln = 148 / INRdf < 50
n = 115 / INRdf >50
n = 33 / p value*†
Creatinine mg/dL
Initial mean ± SD
median, (range)
Peak mean ± SD
median, (range)
Increased after admit / 1.1 ± 0.8
0.8 (0.4 – 6.0)
2.0 ± 2.1
1.0 (0.4 – 13.5)
83/148 (56%) / 1.0 ± 0.7
0.8 (0.4 – 3.7)
1.8 ± 2.1
0.9 (0.4 – 13.5)
59/115 (51%) / 1.4 ± 1.2
0.9 (0.6 – 6.0)
2.6 ± 2.0
1.8 (0.6 – 8.0)
24/33 (73%) / 0.012
0.0011
0.029*
MELD score
Peak mean ± SD
median, (range)
Increased after admit
Peak MELD <21
Peak MELD >31 / 28 ± 9
24 (14 – 54)
86/148 (58%)
47 (32%)
47 (32%) / 25 ± 8
22 (14 – 54)
61/115 (53%)
47 (41%)
23 (20%) / 37 ± 7
37 (26 – 48)
25/33 (76%)
0
24 (73%) / < 0.0001
0.02*
< 0.001†
< 0.001*
* From chi-square test, † Fisher’s exact test; otherwise Wilcoxon (Mann-Whitney) rank sum test.
Supplementary Table C:All-cause Mortality After Index Admission
All known dead† / Dead at 28 days‡ / Dead at 90 days‡ / Dead at 6 months‡ / Dead at 5 years‡Total
No steroids / 107/148 (72%)
98/139 (71%) / 31/101 (23%)
30/131 (23%) / 48/130 (37%)
47/129 (36%) / 61/129 (47%)
60/128 (47%) / 84/121 (69%)
83/120 (69%)
DF*
≤ 32 (n = 68/68)
> 32 (n = 71/80) / 38/68 (56%)
60/71 (85%) / 6/61 (10%)
24/70 (34%) / 16/59 (27%)
31/70 (44%) / 21/59 (36%)
39/69 (57%) / 30/52 (58%)
53/68 (78%)
INRdf*
≤ 50 (n = 113/115)
> 50 (n = 26/33) / 73/113 (65%)
25/26 (97%) / 15/105 (14%)
15/26 (58%) / 30/103 (29%)
17/26 (65%) / 39/103 (38%)
21/25 (84%) / 59/95 (62%)
24/25 (96%)
GAHS*
≤ 9 (n = 116/121)
> 9 (n = 23/27) / 78/116 (67%)
20/23 (87%) / 21/108 (20%)
9/23 (39%) / 34/106 (32%)
13/23 (57%) / 44/106 (42%)
16/22 (73%) / 64/99 (65%)
19/21 (90%)
ABIC score*
6.71(n = 42/43)
6.71 – 9 (n = 36/39)
9 (n = 21/24) / 22/42 (52%)
27/36 (75%)
22/24 (92%) / 5/36 (14%)
6/36 (17%)
12/20 (60%) / 9/35 (26%)
9/36 (25%)
16/20 (80%) / 11/35 (31%)
15/35 (43%)
17/20 (85%) / 18/31 (58%)
24/34 (71%)
17/20 (85%)
Initial MELD*
≤ 21 (n = 63/64)
> 31 (n = 16/19) / 35/63 (56%)
16/16 (100%) / 6/56 (11%)
9/16 (56%) / 15/54 (28%)
12/16 (75%) / 19/54 (35%)
12/16 (75%) / 27/47 (55%)
12/16 (75%)
Peak MELD*
≤ 21 (n = 47/47)
> 31 (n = 43/47) / 23/47 (49%)
41/43 (95%) / 1/42 (2%)
28/43 (65%) / 6/40 (15%)
34/43 (79%) / 9/40 (23%)
36/43 (84%) / 15/34 (44%)
37/43 (86%)
* Limited to those NOT receiving either corticosteroids or pentoxifylline (n = 9)
† No SSN recorded for 17 subjects for accessing death statistics; 11/17 known dead at PHHS, 6/17 unknown outcome
‡ Known outcomes only
Note: The number of more severely affected patients lost to follow-up was small (INRdf > 50, n = 1 (3%) at 5 years). In INRdf < 50, the mild alcoholic hepatitis patients, 7 were missing in the first 28 days (10%) and 18/68 (26%) were missing at 5 years. In the lost to follow-up group, 4 did not have Social Security Numbers on file and could not be traced. A total of 15 subjects with Social Security Numbers were not traceable at 5 years using death certificate data and are presumably long-term survivors.
Supplementary Table D:Comparison of Median Survival for Scoring Systems*
Category / NumberHCV negative / Median Survival / Number
HCV positive / Median Survival
DF < 32 / 52 / 22.3 months / 35 / 8.5 months
DF > 32 / 77 / 4.4 months / 34 / 2.4 months
INRdf < 50 / 97 / 18.1 months / 56 / 6.0 months
INRdf > 50 / 32 / 1.2 months / 13 / 1.2 months
Glasgow < 9 / 104 / 12.2 months / 55 / 5.8 months
Glasgow > 9 / 27 / 1.5 months / 14 / 3.3 months
ABIC6.71 / 42 / 12.4 months / 21 / 6.9 months
ABIC 6.71 - 9 / 36 / 10.7 months / 44 / 3.7 months
ABIC > 9 / 23 / 0.9 months / 9 / 3.5 months
Admission
MELD < 21 / 48 / 19.4 months / 32 / 8.7 months
Admission
MELD > 31 / 19 / 1.1 months / 10 / 0.7 months
Peak
MELD < 21 / 34 / 65.3 months / 22 / 11.1 months
Peak
MELD > 31 / 47 / 0.8 months / 22 / 0.6 months
Results include subjects receiving corticosteroids and/or pentoxifylline (n = 9) and exclude 22 subjects (HCV negative = 17, HCV positive = 5) of unknown status at 5 years
Supplementary TableE: Stepwise Cox Regression Analysis of Predictors of 90 Day Survival*
Variable / Parameter Estimate(± standard error) / HR (95% CI) / p value
Admission parameters
DF / 0.010 (± 0.004) / 1.01 (1.00 – 1.02) / 0.022
ABIC category / 0.59 (± 0.29) / 1.80 (1.02 – 3.19) / 0.043
Admission & peakparameters
Peak MELD 31 category / 2.97 (± 0.46) / 19.54 (7.88 – 48.54) / < 0.001
INRdf category / 1.09 (± 0.40) / 2.97 (1.36 – 6.49) / 0.006
Admission bilirubin / - 0.061(± 0.019) / 0.94 (0.91 – 0.98) / 0.001
* Included all parameters with p < 0.05 on univariate analysis except INR (collinearity)
† Within 2 days of admission
Supplementary Table F:Comparison with Published Data
First author / Control subjects / Age(yrs) / Bilirubin
(mg/dL) / PT
(secs) / Creatinine
(mg/dL) / Albumin
(g/dL) / AST
(U/L) / Maddrey
DF / Mortality
at 28 days
Akriviadis 2000* / 52 / 41 / 20.5 / + 6.0 / 1.2 / 2.7 / 161 / 46 / 46%†
Mathurin 2011* / 197 / 47 / 17.3 / 16 / 1.1 / 2.5 / 96 / 49 / 34%
95% CI / 46 – 50 / 15 – 21 / 16 – 17 / 1.0 – 1.2 / 2.4 – 2.6 / 88 – 105 / 46 – 51
Range / 25 – 71 / 2 – 48 / 11 – 32 / 0.45 – 10.7 / 1.3 – 4.4 / 13 – 462 / 11 – 131
INRdf > 50 / 26‡ / 45 / 22.7 / 26 / 0.9 / 2.4 / 117 / 84 / 58%
95% CI / 34 – 53 / 6 – 44 / 20 – 50 / 0.6 – 5.3 / 1.6 – 3.2 / 60 – 257 / 61 – 185
Range / 30 – 56 / 5 – 47 / 16 – 52 / 0.6 – 6.0 / 1.5 – 3.6 / 59 – 315 / 55 – 193
ABIC > 9 / 21‡ / 52 / 23.8 / 23 / 1.4 / 2.4 / 110 / 83 / 57%
95% CI / 36 – 67 / 7 – 44 / 14 – 50 / 0.6 – 3.3 / 1.7 – 3.0 / 60 – 228 / 35 – 185
Range / 20 – 69 / 5 – 47 / 12 – 52 / 0.6 – 6 / 1.6 – 3.6 / 59 – 257 / 22 – 193
DF > 32 / 71‡ / 45 / 15.8 / 21 / 0.9 / 2.3 / 114 / 53 / 34%
95% CI / 34 – 63 / 6 – 40 / 16 – 41 / 0.5 – 3.3 / 1.6 – 3.5 / 53 – 315 / 33 – 161
Range / 30 – 69 / 3 – 47 / 13 – 52 / 0.4 – 6.0 / 1.5 – 3.6 / 46 – 383 / 33 – 193
Glasgow9 / 23‡ / 52 / 17.5 / 23 / 1.0 / 2.4 / 100 / 75 / 39%
95% CI / 34 – 64 / 4 – 44 / 15 – 50 / 0.6 – 3.0 / 1.6 – 3.6 / 59 – 167 / 19 – 185
Range / 30 – 69 / 3 – 47 / 14 – 52 / 0.5 – 6.0 / 1.6 – 3.9 / 51 – 257 / 14 – 193
* Mean for Akriviadis, median for Mathurin and others [SI conversion = 17.1 (bilirubin) and 88.4 (creatinine)]
† Deaths during hospitalization, time to death = 33 ± 27 days (mean ± SD)
‡ Includes patients of unknown status at 28 days, excludes patients who received corticosteroids and/or pentoxifylline (n = 8 corticosteroids, n = 1 corticosteroids + pentoxifylline)