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

Autor:	Dunn W; Department of Gastroenterology, University of Kansas Medical Center, Kansas, USA., Li Y; Department of Gastroenterology, University of Kansas Medical Center, Kansas, USA., Singal AK; Department of Gastroenterology and Hepatology, University of Louisville, Louisville, Kentucky, USA., Simonetto DA; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Díaz LA; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Idalsoaga F; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Ayares G; Department of Medicine, Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Arnold J; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Ayala-Valverde M; Department of Medicine, Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Perez D; Department of Medicine, Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Gomez J; Department of Medicine, Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Escarate R; Department of Medicine, Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Fuentes-López E; Department of Health Sciences, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Ramirez-Cadiz C; Department of Anesthesiology and Perioperative Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada., Morales-Arraez D; Department of Medicine, Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pennsylvania, USA., Zhang W; Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.; Department of Medicine, Center for Liver Disease and Liver Transplantation, Columbia University, New York, New York, USA., Qian S; Department of Medicine, Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Ahn JC; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Buryska S; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Mehta H; Department of Gastroenterology, University of Kansas Medical Center, Kansas, USA., Dunn N; Department of Gastroenterology, University of Kansas Medical Center, Kansas, USA., Waleed M; Department of Gastroenterology and Hepatology, University of Louisville, Louisville, Kentucky, USA., Stefanescu H; Department of Medicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania., Bumbu A; Department of Medicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania., Horhat A; University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj-Napoca, Romania., Attar B; Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health, and Hospital Systems, Chicago, Illinois, USA., Agrawal R; Division of Gastroenterology and Hepatology, Department of Medicine, University of West Virginia, West Virginia, USA., Cabezas J; Department of Gastroenterology and Hepatology, University Hospital Marqués de Valdecilla, Santander, Spain.; Clinical and Translational Research in Digestive Diseases, Research Institute Valdecilla (IDIVAL). Santander, Spain., Echavaría V; Department of Gastroenterology and Hepatology, University Hospital Marqués de Valdecilla, Santander, Spain.; Clinical and Translational Research in Digestive Diseases, Research Institute Valdecilla (IDIVAL). Santander, Spain., Cuyàs B; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Poca M; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Soriano G; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Sarin SK; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India., Maiwall R; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India., Jalal PK; Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA., Higuera-de-la-Tijera F; Department of Medicine, Servicio de Gastroenterología y Hepatología, Hospital General de México 'Dr. Eduardo Liceaga'; Facultad de Medicina, Universidad Nacional Autónoma de México, México., Kulkarni AV; Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India., Rao PN; Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India., Guerra-Salazar P; Instituto de Gastroenterología Boliviano-Japonés, Cochabamba, Bolivia., Skladaný L; Department of Internal Medicine II, Division of Hepatology, Gastroenterology and Liver Transplantation, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic., Kubánek N; Department of Internal Medicine II, Division of Hepatology, Gastroenterology and Liver Transplantation, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic., Prado V; Department of Medicine, Centre Hospitalier de Luxembourg, Luxembourg., Clemente-Sanchez A; Department of Medicine, Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pennsylvania, USA.; Department of Digestive Diseases, Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; CIBERehd Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain., Rincon D; Department of Digestive Diseases, Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Haider T; Division of Gastroenterology and Hepatology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA., Chacko KR; Division of Gastroenterology and Hepatology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA., Romero GA; Department of Medicine, Sección Hepatología, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Pollarsky FD; Department of Medicine, Sección Hepatología, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Restrepo JC; Unidad de Hepatología del Hospital Pablo Tobon Uribe, Grupo de Gastrohepatología de la Universidad de Antioquia, Medellín, Colombia., Toro LG; Department of Medicine, Hepatology and Liver Transplant Unit, Hospitales de San Vicente Fundación de Medellín y Rionegro, Colombia., Yaquich P; Departamento de Gastroenterología, Hospital San Juan de Dios, Santiago, Chile., Mendizabal M; Department of Medicine, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina., Garrido ML; Hospital Central San Luis, San Luis, Argentina., Marciano S; Department of Medicine, Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Dirchwolf M; Department of Medicine, Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina., Vargas V; Department of Medicine, Liver Unit, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Jiménez C; Department of Medicine, Liver Unit, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Hudson D; Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada., García-Tsao G; Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven, CT, USA., Ortiz G; Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven, CT, USA., Abraldes JG; Division of Gastroenterology, Department of Medicine, Liver Unit, University of Alberta, Edmonton, Canada., Kamath PS; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Arrese M; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Shah VH; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Bataller R; Department of Medicine, Liver Unit, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain., Arab JP; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Hepatology (Baltimore, Md.) [Hepatology] 2024 Nov 01; Vol. 80 (5), pp. 1196-1211. Date of Electronic Publication: 2024 Apr 12.
DOI:	10.1097/HEP.0000000000000883
Abstrakt:	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/ . (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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