EARLY IDENTIFICATION OF LIVER TRANSPLANTATION REQUIREMENT IN ALCOHOL-ASSOCIATED HEPATITIS
Bibliographic record
Abstract
Severe alcohol‐associated hepatitis (AH) has a high risk of short-term mortality especially in those r with acute‐on‐chronic liver failure (ACLF). Delayed evaluation for liver transplantation (LT) in severe AH often worsens nutritional and functional status. This study aimed to identify early mortality predictors. In a prospective study, 981 adults with AH were enrolled from 32 centers in 14 countries (January 2015–September 2024). ACLF was classified by EASL-CLIF criteria. Primary outcomes were 30- and 90-day mortality. Competing-risk regression (LT as the competing event) and receiver-operating-characteristic (AUROC) analyses evaluated clinical scores predicting development of ACLF grades 2–3 within seven days of admission. The mean age was 48.3 ± 11.2 years, and 88.7% were male. Within the first week, 68.8% of patients had ACLF—30.1% with grade 1, 34.5% with grade 2, and 35.4% with grade 3. Overall survival rates were 84.7% at 30 days and 75.8% at 90 days. Adjusted analyses identified increasing age, infections, higher admission MELD score, and ACLF grades 2 (subdistribution hazard ratio [sHR] 1.59) and 3 (sHR 2.58) as independent predictors of 90-day mortality. The MELD score was the best predictor of developing ACLF grades 2–3 (AUROC 0.869), with MELD ≥28 showing 64% sensitivity and 90% specificity. These findings were confirmed in two external validation cohorts: a prospectively enrolled U.S. cohort (n=234) and a retrospective cohort from seven countries (n=602). ACLF and infections are key determinants of mortality in severe AH. The MELD score at admission is a robust early predictor of high‐grade ACLF, supporting its use to determine LT candidacy earlier.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".