Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis

• Published in: Digestive diseases and sciences Vol. 67; no. 9; pp. 4395 - 4402
• Main Authors: Panchal, Sarjukumar A., Kaplan, David E., Goldberg, David S., Mahmud, Nadim
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2022; Springer; Springer Nature B.V
• Subjects: Algorithms; Bilirubin; Biochemistry; Care and treatment; Development and progression; Epidemiology; Gastroenterology; Health aspects; Hepatitis; Hepatology; Hospitalization; Liver; Liver cirrhosis; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mortality; Oncology; Original Article; Transplant Surgery; Transplantation of organs, tissues, etc; Veterans; Administrative; Validated; Veterans affairs; Alcoholic hepatitis; Hospitalizations; Algorithm
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-021-07321-7

Background Alcoholic hepatitis (AH) is a clinically diagnosed syndrome with high short-term mortality for which liver transplantation may be curative. A lack of validated algorithms to identify AH hospitalizations has hindered clinical epidemiology research. Methods This was a retrospective cohort study of patients with cirrhosis using Veterans Health Administration (VHA) data from 2008 to 2015. We randomly sampled hospitalizations based upon abnormal liver tests and administrative codes for acute hepatitis or alcohol-associated liver disease (ALD). Hospitalizations were manually adjudicated for AH per society guidelines. A priori algorithms were evaluated to compute positive predicted value (PPV) and positive likelihood ratio (LR+), and were tested in an external University of Pennsylvania Health System (UPHS) cohort. Results Of 368 hospitalizations, 142 (38.6%) were adjudicated as AH. AH patients were younger (55 vs. 58 years, p  < 0.001), less likely to have prior cirrhosis decompensation (57% vs. 73.9%, p  < 0.001), and had higher AST-to-ALT ratios (median 2.9 vs. 1.9 mg/dL, p  < 0.001) and higher bilirubin levels (median 2.9 vs. 1.9 mg/dL, p  < 0.001). Algorithms combining clinical laboratory criteria (AST > 85 U/L but < 450 U/L, AST-to-ALT ratio > 2, total bilirubin > 5 mg/dL) and administrative coding criteria yielded the highest PPV (96.4%, 95% CI 87.7–99.6) and the highest LR+ (43.0, 95% CI 10.6–173.5). Several algorithms demonstrated 100% PPV for definite AH in the UPHS external cohort. Conclusion We have identified algorithms for AH hospitalizations with excellent PPV and LR+. These high-specificity algorithms may be used in VHA datasets to identify patients with high likelihood of AH, but should not be used to study AH incidence.