Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 1, February 2023, pages 25-36

The Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis

Figure 4. Forest plot of variables with significant P-value (< 0.05). For one unit increase of BMI, the mortality risk will decrease by 14%. BMI: body mass index.

Figure 5. Kaplan-Meier mortality risk. (a) Stratified based upon metabolic syndrome and MELD status. (b) Stratified based upon metabolic syndrome and DF. MELD: model for end-stage liver disease; DF: discriminant function.

**Table 1.** Clinical Features Based Upon Metabolic Syndrome (t-Test, Chi-Square)
Variable	Overall (N = 109)	Alcohol hepatitis (N = 62)	Alcohol hepatitis with metabolic syndrome (N = 47)	P-value*
Data are presented as mean ± SD or n (%). *Derived from Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; T. bili: total bilirubin; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; MELD: model for end-stage liver disease; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index.
Age	47.49 ± 12.72	47.50 ± 11.90	47.47 ± 13.87	0.67
Female	43.00 (39.45%)	29.00 (46.77%)	14.00 (29.79%)	0.08
Race				0.38
Caucasian	72.00 (66.06%)	43.00 (69.35%)	29.00 (61.70%)
Hispanic	24.00 (22.02%)	14.00 (22.58%)	10.00 (21.28%)
Others	13.00 (11.93%)	5.00 (8.06%)	8.00 (17.02%)
Diabetic	12.00 (11.11%)	0.00 (0.00%)	12.00 (25.53%)	< 0.001
BMI	26.85 ± 7.12	23.57 ± 3.64	30.97 ± 8.24	< 0.001
WBC	10.66 ± 5.97	10.57 ± 6.09	10.79 ± 5.86	0.67
Hb	12.04 ± 2.85	11.36 ± 2.40	12.94 ± 3.16	< 0.01
Hct	34.96 ± 8.59	32.84 ± 7.78	37.77 ± 8.87	< 0.01
MCV	97.20 ± 8.58	96.33 ± 9.16	98.34 ± 7.67	0.37
Platelets	185.06 ± 118.04	188.48 ± 130.47	180.53 ± 100.51	0.75
Creatinine	1.35 ± 1.38	1.17 ± 0.96	1.59 ± 1.77	0.06
INR	2.62 ± 4.63	2.26 ± 4.04	3.10 ± 5.32	0.76
PT	27.28 ± 33.98	23.87 ± 29.92	31.70 ± 38.52	0.32
AST	243.66 ± 552.55	194.19 ± 243.90	308.91 ± 793.91	0.46
ALT	141.52 ± 357.81	105.98 ± 133.78	188.40 ± 522.40	0.46
AP	158.62 ± 117.41	165.90 ± 128.99	148.63 ± 99.98	0.69
Albumin	2.91 ± 0.89	3.02 ± 0.92	2.76 ± 0.85	0.14
< 3.5	64.00 (58.72%)	34.00 (54.84%)	30.00 (63.83%)	0.43
T. bili	6.23 ± 8.52	6.57 ± 8.99	5.78 ± 7.93	0.88
Na	134.02 ± 6.87	133.42 ± 6.87	134.81 ± 6.88	0.58
Lactate	3.48 ± 3.25	3.05 ± 3.11	4.20 ± 4.04	0.45
AST/ALT ratio	2.25 ± 1.45	2.45 ± 1.59	2.00 ± 1.20	0.19
AST/AP ratio	1.86 ± 3.42	1.60 ± 2.66	2.23 ± 4.26	0.73
ALT/AP ratio	1.05 ± 2.64	0.86 ± 1.37	1.31 ± 3.76	0.47
ALT/AP index	2.76 ± 6.94	2.25 ± 3.59	3.45 ± 9.86	0.47
AST/AP index	4.88 ± 8.98	4.19 ± 6.99	5.84 ± 11.17	0.73
NR-ALT/AP index	5.80 ± 14.62	4.75 ± 7.55	7.25 ± 20.77	0.47
NR-AST/AP index	10.28 ± 18.91	8.82 ± 14.72	12.30 ± 23.52	0.73
Fib-4	7.88 ± 12.93	7.70 ± 9.05	8.12 ± 16.85	0.46
APRI	5.47 ± 18.39	4.37 ± 8.16	6.91 ± 26.49	0.67
HAI	36.00 (33.03%)	16.00 (25.81%)	20.00 (42.55%)	0.10
Antimicrobial	54.00 (49.54%)	28.00 (45.16%)	26.00 (55.32%)	0.34
CTP	8.32 ± 2.65	8.29 ± 2.83	8.35 ± 2.46	0.80
MELD	16.48 ± 14.23	14.90 ± 13.83	18.56 ± 14.64	0.14
≥ 21	29.00 (26.61%)	15.00 (24.19%)	14.00 (29.79%)	0.52
≥ 18	37.00 (33.94%)	19.00 (30.65%)	18.00 (38.30%)	0.42
DF	75.34 ± 157.87	59.39 ± 140.28	96.39 ± 177.83	0.22
≥ 32	41.00 (37.61%)	22.00 (35.48%)	19.00 (40.43%)	0.69
ANI	1.63 ± 9.16	3.34 ± 9.44	-0.62 ± 8.34	0.02
≥ 2.2	73.00 (66.97%)	43.00 (69.35%)	30.00 (63.83%)	0.68

Table 1. Clinical Features Based Upon Metabolic Syndrome (t-Test, Chi-Square)

Variable

Overall (N = 109)

Alcohol hepatitis (N = 62)

Alcohol hepatitis with metabolic syndrome (N = 47)

P-value*

Data are presented as mean ± SD or n (%). *Derived from Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; T. bili: total bilirubin; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; MELD: model for end-stage liver disease; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index.

Age

47.49 ± 12.72

47.50 ± 11.90

47.47 ± 13.87

0.67

Female

43.00 (39.45%)

29.00 (46.77%)

14.00 (29.79%)

0.08

Race

0.38

Caucasian

72.00 (66.06%)

43.00 (69.35%)

29.00 (61.70%)

Hispanic

24.00 (22.02%)

14.00 (22.58%)

10.00 (21.28%)

Others

13.00 (11.93%)

5.00 (8.06%)

8.00 (17.02%)

Diabetic

12.00 (11.11%)

0.00 (0.00%)

12.00 (25.53%)

< 0.001

BMI

26.85 ± 7.12

23.57 ± 3.64

30.97 ± 8.24

< 0.001

WBC

10.66 ± 5.97

10.57 ± 6.09

10.79 ± 5.86

0.67

12.04 ± 2.85

11.36 ± 2.40

12.94 ± 3.16

< 0.01

Hct

34.96 ± 8.59

32.84 ± 7.78

37.77 ± 8.87

< 0.01

MCV

97.20 ± 8.58

96.33 ± 9.16

98.34 ± 7.67

0.37

Platelets

185.06 ± 118.04

188.48 ± 130.47

180.53 ± 100.51

0.75

Creatinine

1.35 ± 1.38

1.17 ± 0.96

1.59 ± 1.77

0.06

INR

2.62 ± 4.63

2.26 ± 4.04

3.10 ± 5.32

0.76

27.28 ± 33.98

23.87 ± 29.92

31.70 ± 38.52

0.32

AST

243.66 ± 552.55

194.19 ± 243.90

308.91 ± 793.91

0.46

ALT

141.52 ± 357.81

105.98 ± 133.78

188.40 ± 522.40

0.46

158.62 ± 117.41

165.90 ± 128.99

148.63 ± 99.98

0.69

Albumin

2.91 ± 0.89

3.02 ± 0.92

2.76 ± 0.85

0.14

< 3.5

64.00 (58.72%)

34.00 (54.84%)

30.00 (63.83%)

0.43

T. bili

6.23 ± 8.52

6.57 ± 8.99

5.78 ± 7.93

0.88

134.02 ± 6.87

133.42 ± 6.87

134.81 ± 6.88

0.58

Lactate

3.48 ± 3.25

3.05 ± 3.11

4.20 ± 4.04

0.45

AST/ALT ratio

2.25 ± 1.45

2.45 ± 1.59

2.00 ± 1.20

0.19

AST/AP ratio

1.86 ± 3.42

1.60 ± 2.66

2.23 ± 4.26

0.73

ALT/AP ratio

1.05 ± 2.64

0.86 ± 1.37

1.31 ± 3.76

0.47

ALT/AP index

2.76 ± 6.94

2.25 ± 3.59

3.45 ± 9.86

0.47

AST/AP index

4.88 ± 8.98

4.19 ± 6.99

5.84 ± 11.17

0.73

NR-ALT/AP index

5.80 ± 14.62

4.75 ± 7.55

7.25 ± 20.77

0.47

NR-AST/AP index

10.28 ± 18.91

8.82 ± 14.72

12.30 ± 23.52

0.73

Fib-4

7.88 ± 12.93

7.70 ± 9.05

8.12 ± 16.85

0.46

APRI

5.47 ± 18.39

4.37 ± 8.16

6.91 ± 26.49

0.67

HAI

36.00 (33.03%)

16.00 (25.81%)

20.00 (42.55%)

0.10

Antimicrobial

54.00 (49.54%)

28.00 (45.16%)

26.00 (55.32%)

0.34

CTP

8.32 ± 2.65

8.29 ± 2.83

8.35 ± 2.46

0.80

MELD

16.48 ± 14.23

14.90 ± 13.83

18.56 ± 14.64

0.14

≥ 21

29.00 (26.61%)

15.00 (24.19%)

14.00 (29.79%)

0.52

≥ 18

37.00 (33.94%)

19.00 (30.65%)

18.00 (38.30%)

0.42

75.34 ± 157.87

59.39 ± 140.28

96.39 ± 177.83

0.22

≥ 32

41.00 (37.61%)

22.00 (35.48%)

19.00 (40.43%)

0.69

ANI

1.63 ± 9.16

3.34 ± 9.44

-0.62 ± 8.34

0.02

≥ 2.2

73.00 (66.97%)

43.00 (69.35%)

30.00 (63.83%)

0.68

**Table 2.** Identification of Factors Associated With Combined Alcohol Hepatitis With Metabolic Syndrome (Logistic Regression, Stepwise Regression)
Variable	Unadjusted^a	Adjusted^b
^aDerived from logistic regression. ^bStepwise selection with an entry P-value of 0.05 and a removal P-value of 0.05 was performed to select variables, in which lactate was excluded due to an extremely high missing rate > 90%. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; Cr: creatinine; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; AAPI1: ALT/AP index; AAPI2: AST/AP index; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index; OR: odds ratio; CI: confidence interval.
Age	1.00 (0.97 - 1.03)	0.99
Female	0.48 (0.22 - 1.07)	0.07
Race (vs. Caucasian)		0.37
Hispanic	1.06 (0.41 - 2.71)	0.90
Others	2.37 (0.71 - 7.98)	0.16
BMI (n = 106)	1.26 (1.14 - 1.39)	< 0.0001	1.34 (1.17 - 1.54)	< 0.0001
WBC	1.01 (0.94 - 1.07)	0.85
Hb	1.23 (1.06 - 1.43)	< 0.01
Hct	1.08 (1.02 - 1.14)	< 0.01
MCV	1.03 (0.98 - 1.08)	0.23
Platelets	0.999 (0.996 - 1.003)	0.73
Cr	1.28 (0.92 - 1.77)	0.14
INR	1.04 (0.96 - 1.13)	0.36
PT (n = 107)	1.01 (0.995 - 1.019)	0.25
AST	1.000 (1.000 - 1.001)	0.33
ALT	1.001 (0.999 - 1.003)	0.32
AP (n = 102)	0.999 (0.995 - 1.002)	0.46
Albumin	0.71 (0.46 - 1.10)	0.12
< 3.5	1.39 (0.62 - 3.13)	0.43
Total bilirubin	0.99 (0.98 - 1.04)	0.63
Na	1.03 (0.97 - 1.09)	0.30
Lactate (n = 8)	1.13 (0.71 - 1.80)	0.61
AST/ALT ratio	0.79 (0.59 - 1.06)	0.11
ALT/AP ratio (n = 102)	1.07 (0.90 - 1.28)	0.43
AST/AP ratio (n = 102)	1.06 (0.94 - 1.19)	0.37
AAPI1 (n = 102)	1.03 (0.96 - 1.10)	0.43
AAPI2 (n = 102)	1.02 (0.98 - 1.07)	0.37
NR ALT/AP (n = 102)	1.01 (0.98 - 1.05)	0.43
NR AST/AP (n = 102)	1.01 (0.99 - 1.03)	0.37
Fib-4	1.00 (0.97 - 1.03)	0.86
APRI	1.01 (0.99 - 1.03)	0.50
CTP (n = 88)	1.01 (0.86 - 1.18)	0.92
Infection	2.13 (0.95 - 4.79)	0.05
Antibiotics use	1.50 (0.70 - 3.22)	0.29
MELD	1.02 (0.99 - 1.05)	0.19
≥ 21	1.33 (0.57 - 3.12)	0.51
≥ 18	1.41 (0.63 - 3.12)	0.40
DF	1.002 (0.999 - 1.004)	0.24
≥ 32	1.23 (0.57 - 2.69)	0.60
ANI	0.95 (0.91 - 0.995)	0.03
≥ 2.2	0.78 (0.35 - 1.74)	0.54

Table 2. Identification of Factors Associated With Combined Alcohol Hepatitis With Metabolic Syndrome (Logistic Regression, Stepwise Regression)

Variable

Unadjusted^a

Adjusted^b

OR (95% CI)^a

P value

OR (95% CI)

P value

^aDerived from logistic regression. ^bStepwise selection with an entry P-value of 0.05 and a removal P-value of 0.05 was performed to select variables, in which lactate was excluded due to an extremely high missing rate > 90%. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; Cr: creatinine; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; AAPI1: ALT/AP index; AAPI2: AST/AP index; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index; OR: odds ratio; CI: confidence interval.

Age

1.00 (0.97 - 1.03)

0.99

Female

0.48 (0.22 - 1.07)

0.07

Race (vs. Caucasian)

0.37

Hispanic

1.06 (0.41 - 2.71)

0.90

Others

2.37 (0.71 - 7.98)

0.16

BMI (n = 106)

1.26 (1.14 - 1.39)

< 0.0001

1.34 (1.17 - 1.54)

< 0.0001

WBC

1.01 (0.94 - 1.07)

0.85

1.23 (1.06 - 1.43)

< 0.01

Hct

1.08 (1.02 - 1.14)

< 0.01

MCV

1.03 (0.98 - 1.08)

0.23

Platelets

0.999 (0.996 - 1.003)

0.73

1.28 (0.92 - 1.77)

0.14

INR

1.04 (0.96 - 1.13)

0.36

PT (n = 107)

1.01 (0.995 - 1.019)

0.25

AST

1.000 (1.000 - 1.001)

0.33

ALT

1.001 (0.999 - 1.003)

0.32

AP (n = 102)

0.999 (0.995 - 1.002)

0.46

Albumin

0.71 (0.46 - 1.10)

0.12

< 3.5

1.39 (0.62 - 3.13)

0.43

Total bilirubin

0.99 (0.98 - 1.04)

0.63

1.03 (0.97 - 1.09)

0.30

Lactate (n = 8)

1.13 (0.71 - 1.80)

0.61

AST/ALT ratio

0.79 (0.59 - 1.06)

0.11

ALT/AP ratio (n = 102)

1.07 (0.90 - 1.28)

0.43

AST/AP ratio (n = 102)

1.06 (0.94 - 1.19)

0.37

AAPI1 (n = 102)

1.03 (0.96 - 1.10)

0.43

AAPI2 (n = 102)

1.02 (0.98 - 1.07)

0.37

NR ALT/AP (n = 102)

1.01 (0.98 - 1.05)

0.43

NR AST/AP (n = 102)

1.01 (0.99 - 1.03)

0.37

Fib-4

1.00 (0.97 - 1.03)

0.86

APRI

1.01 (0.99 - 1.03)

0.50

CTP (n = 88)

1.01 (0.86 - 1.18)

0.92

Infection

2.13 (0.95 - 4.79)

0.05

Antibiotics use

1.50 (0.70 - 3.22)

0.29

MELD

1.02 (0.99 - 1.05)

0.19

≥ 21

1.33 (0.57 - 3.12)

0.51

≥ 18

1.41 (0.63 - 3.12)

0.40

1.002 (0.999 - 1.004)

0.24

≥ 32

1.23 (0.57 - 2.69)

0.60

ANI

0.95 (0.91 - 0.995)

0.03

≥ 2.2

0.78 (0.35 - 1.74)

0.54

**Table 3.** Identification of Factors Associated With Survival (Cox Regression)
Variable	Unadjusted (n = 108)	Adjusted^a (n = 105)	Adjusted^b (n = 105)
Derived from Cox regression. Stepwise selection with an entry P-value of 0.05 and a removal P-value of 0.05 was performed to select variables, in which lactate was not included due to an extremely high missing rate > 90%. ^aAdjusted for age, BMI, WBC, albumin, Na, MELD, and IR. ^bAdjusted for age, BMI, WBC, albumin, Na, DF, and IR. Note: One patient had a survival time < 0 so this patient was excluded from survival analysis. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; Cr: creatinine; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; AAPI1: ALT/AP index; AAPI2: AST/AP index; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index; HR: hazard ratio; CI: confidence interval.
Age	1.05 (1.02 - 1.08)	< 0.001	1.05 (1.01 - 1.08)	< 0.01	1.05 (1.02 - 1.09)	< 0.01
Female	1.21 (0.58 - 2.54)	0.62
Race (vs. Caucasian)		0.26
Hispanic	1.67 (0.75 - 3.73)	0.21
Others	0.54 (0.13 - 2.35)	0.41
BMI (n = 105)	0.98 (0.93 - 1.04)	0.47	0.91 (0.84 - 0.98)	0.02	0.92 (0.86 - 0.98)	0.01
WBC	1.09 (1.03 - 1.14)	< 0.01	1.04 (0.97 - 1.12)	0.28	1.07 (0.99 - 1.16)	0.08
Hb	0.89 (0.77 - 1.02)	0.08
Hct	0.98 (0.94 - 1.02)	0.25
MCV	1.01 (0.96 - 1.06)	0.72
Platelet	1.001 (0.998 - 1.004)	0.41
Cr	1.57 (1.32 -1.87)	< 0.0001
INR	1.07 (1.01 - 1.13)	0.02
PT (n = 107)	1.013 (1.005 - 1.020)	< 0.01
AST	1.000 (0.999 - 1.001)	0.63
ALT	1.000 (0.999 - 1.001)	0.92
AP (n = 102)	1.001 (0.998 - 1.004)	0.56
Albumin	0.38 (0.24 - 0.62)	< 0.0001	0.63 (0.34 - 1.15)	0.13	0.53 (0.30 - 0.96)	0.03
< 3.5	9.47 (2.24 - 39.96)	< 0.01
Total bilirubin	1.04 (1.01 - 1.08)	< 0.01
Na	0.92 (0.88 - 0.97)	< 0.01	0.95 (0.89 - 1.02)	0.14	0.94 (0.88 - 0.996)	0.04
Lactate (n = 8)	1.19 (0.79 - 1.78)	0.41
AST/ALT	1.08 (0.83 - 1.42)	0.56
ALT/AP (n = 102)	0.98 (0.80 - 1.21)	0.85
AST/AP (n = 102)	1.01 (0.89 - 1.13)	0.94
AAPI1 (n = 102)	0.99 (0.92 - 1.07)	0.85
AAPI2 (n = 102)	1.00 (0.96 - 1.05)	0.94
NR ALT/AP (n = 102)	1.00 (0.96 - 1.04)	0.85
NR AST/AP (n = 102)	1.00 (0.98 - 1.02)	0.94
FIB 4	1.01 (0.98 - 1.03)	0.59
APRI	1.00 (0.98 - 1.02)	0.89
CTP (n = 87)	1.44 (1.21 - 1.71)	< 0.0001
Infection	1.95 (0.93 - 4.07)	0.08
Antibiotics use (Y/N)	2.05 (0.96 - 4.38)	0.06
MELD	1.06 (1.03 - 1.08)	< 0.0001	1.04 (1.01 - 1.08)	< 0.01
≥ 21	5.81 (2.74 - 12.30)	< 0.0001
≥18	5.30 (2.46 - 11.40)	< 0.0001
DF	1.003 (1.001 - 1.004)	< 0.001			1.003 (1.001 - 1.005)	< 0.01
≥ 32	4.62 (2.14 - 9.99)	0.0001
ANI	1.02 (0.98 - 1.07)	0.24
≥ 2.2	1.17 (0.52 - 2.65)	0.71
IR	1.37 (0.66 - 2.84)	0.40	2.63 (1.08 - 6.40)	0.03	2.84 (1.13 - 7.13)	0.03

Table 3. Identification of Factors Associated With Survival (Cox Regression)

Variable

Unadjusted (n = 108)

Adjusted^a (n = 105)

Adjusted^b (n = 105)

HR (95% CI)^a

P value

HR (95% CI)

P value

HR (95% CI)

P value

Derived from Cox regression. Stepwise selection with an entry P-value of 0.05 and a removal P-value of 0.05 was performed to select variables, in which lactate was not included due to an extremely high missing rate > 90%. ^aAdjusted for age, BMI, WBC, albumin, Na, MELD, and IR. ^bAdjusted for age, BMI, WBC, albumin, Na, DF, and IR. Note: One patient had a survival time < 0 so this patient was excluded from survival analysis. BMI: body mass index; WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; MCV: mean corpuscular volume; Cr: creatinine; INR: international normalized ratio; PT: prothrombin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; AP: alkaline phosphatase; AAPI1: ALT/AP index; AAPI2: AST/AP index; Fib-4: fibrosis-4; APRI: aspartate aminotransferase to platelet ratio index; CTP: Child-Turcotte-Pugh; DF: discriminant function; ANI: alcoholic liver disease/non-alcoholic fatty liver disease index; HR: hazard ratio; CI: confidence interval.

Age

1.05 (1.02 - 1.08)

< 0.001

1.05 (1.01 - 1.08)

< 0.01

1.05 (1.02 - 1.09)

< 0.01

Female

1.21 (0.58 - 2.54)

0.62

Race (vs. Caucasian)

0.26

Hispanic

1.67 (0.75 - 3.73)

0.21

Others

0.54 (0.13 - 2.35)

0.41

BMI (n = 105)

0.98 (0.93 - 1.04)

0.47

0.91 (0.84 - 0.98)

0.02

0.92 (0.86 - 0.98)

0.01

WBC

1.09 (1.03 - 1.14)

< 0.01

1.04 (0.97 - 1.12)

0.28

1.07 (0.99 - 1.16)

0.08

0.89 (0.77 - 1.02)

0.08

Hct

0.98 (0.94 - 1.02)

0.25

MCV

1.01 (0.96 - 1.06)

0.72

Platelet

1.001 (0.998 - 1.004)

0.41

1.57 (1.32 -1.87)

< 0.0001

INR

1.07 (1.01 - 1.13)

0.02

PT (n = 107)

1.013 (1.005 - 1.020)

< 0.01

AST

1.000 (0.999 - 1.001)

0.63

ALT

1.000 (0.999 - 1.001)

0.92

AP (n = 102)

1.001 (0.998 - 1.004)

0.56

Albumin

0.38 (0.24 - 0.62)

< 0.0001

0.63 (0.34 - 1.15)

0.13

0.53 (0.30 - 0.96)

0.03

< 3.5

9.47 (2.24 - 39.96)

< 0.01

Total bilirubin

1.04 (1.01 - 1.08)

< 0.01

0.92 (0.88 - 0.97)

< 0.01

0.95 (0.89 - 1.02)

0.14

0.94 (0.88 - 0.996)

0.04

Lactate (n = 8)

1.19 (0.79 - 1.78)

0.41

AST/ALT

1.08 (0.83 - 1.42)

0.56

ALT/AP (n = 102)

0.98 (0.80 - 1.21)

0.85

AST/AP (n = 102)

1.01 (0.89 - 1.13)

0.94

AAPI1 (n = 102)

0.99 (0.92 - 1.07)

0.85

AAPI2 (n = 102)

1.00 (0.96 - 1.05)

0.94

NR ALT/AP (n = 102)

1.00 (0.96 - 1.04)

0.85

NR AST/AP (n = 102)

1.00 (0.98 - 1.02)

0.94

FIB 4

1.01 (0.98 - 1.03)

0.59

APRI

1.00 (0.98 - 1.02)

0.89

CTP (n = 87)

1.44 (1.21 - 1.71)

< 0.0001

Infection

1.95 (0.93 - 4.07)

0.08

Antibiotics use (Y/N)

2.05 (0.96 - 4.38)

0.06

MELD

1.06 (1.03 - 1.08)

< 0.0001

1.04 (1.01 - 1.08)

< 0.01

≥ 21

5.81 (2.74 - 12.30)

< 0.0001

≥18

5.30 (2.46 - 11.40)

< 0.0001

1.003 (1.001 - 1.004)

< 0.001

1.003 (1.001 - 1.005)

< 0.01

≥ 32

4.62 (2.14 - 9.99)

0.0001

ANI

1.02 (0.98 - 1.07)

0.24

≥ 2.2

1.17 (0.52 - 2.65)

0.71

1.37 (0.66 - 2.84)

0.40

2.63 (1.08 - 6.40)

0.03

2.84 (1.13 - 7.13)

0.03

**Table 4.** Comparison of Various Models to Determine Important Factors to Predict Mortality
Model	Formula	Uno’s C-statistic
Based on the comparisons in the difference of Uno’s C-statistic between all of the models, MELD ≥ 21 and DF ≥ 32 alone was significantly worse than model 1 - 14 with a P-value < 0.05. In contrast, the differences in Uno’s C-statistic between all the 14 models were not significantly different with a P-value > 0.05. MELD: model for end-stage liver disease; DF: discriminant function; IR: insulin resistance.
MELD ≥ 21	NA	0.65
DF ≥ 32	NA	0.64
Model 1	h(t) = h₀(t)exp(0.034 × Age + 1.474 × MELD ≥ 21)	0.78
Model 2	h(t) = h₀(t)exp(0.037 × Age + 1.243 × DF ≥ 32)	0.75
Model 3	h(t) = h₀(t)exp(1.337 × MELD ≥ 21 + 2.025 × Albumin < 3.5)	0.76
Model 4	h(t) = h₀(t)exp(1.082 × DF ≥ 32 + 1.857 × Albumin < 3.5)	0.74
Model 5	h(t) = h₀(t)exp(0.028 × Age + 1.154 × MELD ≥ 21 + 1.704 × Albumin < 3.5)	0.82
Model 6	h(t) = h₀(t)exp(0.032 × Age + 0.907 × DF ≥ 32 + 1.737 × Albumin < 3.5)	0.79
Model 7	h(t) = h₀(t)exp(0.034 × Age + 1.506 × MELD ≥ 21 + 0.412 × IR)	0.73
Model 8	h(t) = h₀(t)exp(0.037 × Age + 1.223 × DF ≥ 32 + 0.210 × IR)	0.73
Model 9	h(t) = h₀(t)exp(0.033 × Age + 1.445 × MELD ≥ 21 + 0.147 × Infection)	0.78
Model 10	h(t) = h₀(t)exp(0.036 × Age + 1.208 × DF ≥ 32 + 0.204 × Infection)	0.75
Model 11	h(t) = h₀(t)exp(0.034 × Age + 1.491 × MELD ≥ 21 + 0.401 × IR + 0.084 × Infection)	0.73
Model 12	h(t) = h₀(t)exp(0.036 × Age + 1.197 × DF ≥ 32 + 0.186 × IR + 0.175 × Infection)	0.73
Model 13	h(t) = h₀(t)exp(0.027 × Age + 1.191 × MELD ≥ 21 + 1.665 × Albumin < 3.5 + 0.315 × IR + 0.087 × Infection)	0.79
Model 14	h(t) = h₀(t)exp(0.031 × Age + 0.885 × DF ≥ 32 + 1.718 × Albumin < 3.5 + 0.118 × IR + 0.099 × Infection)	0.80

Table 4. Comparison of Various Models to Determine Important Factors to Predict Mortality

Model

Formula

Uno’s C-statistic

Based on the comparisons in the difference of Uno’s C-statistic between all of the models, MELD ≥ 21 and DF ≥ 32 alone was significantly worse than model 1 - 14 with a P-value < 0.05. In contrast, the differences in Uno’s C-statistic between all the 14 models were not significantly different with a P-value > 0.05. MELD: model for end-stage liver disease; DF: discriminant function; IR: insulin resistance.

MELD ≥ 21

0.65

DF ≥ 32

0.64

Model 1

h(t) = h₀(t)exp(0.034 × Age + 1.474 × MELD ≥ 21)

0.78

Model 2

h(t) = h₀(t)exp(0.037 × Age + 1.243 × DF ≥ 32)

0.75

Model 3

h(t) = h₀(t)exp(1.337 × MELD ≥ 21 + 2.025 × Albumin < 3.5)

0.76

Model 4

h(t) = h₀(t)exp(1.082 × DF ≥ 32 + 1.857 × Albumin < 3.5)

0.74

Model 5

h(t) = h₀(t)exp(0.028 × Age + 1.154 × MELD ≥ 21 + 1.704 × Albumin < 3.5)

0.82

Model 6

h(t) = h₀(t)exp(0.032 × Age + 0.907 × DF ≥ 32 + 1.737 × Albumin < 3.5)

0.79

Model 7

h(t) = h₀(t)exp(0.034 × Age + 1.506 × MELD ≥ 21 + 0.412 × IR)

0.73

Model 8

h(t) = h₀(t)exp(0.037 × Age + 1.223 × DF ≥ 32 + 0.210 × IR)

0.73

Model 9

h(t) = h₀(t)exp(0.033 × Age + 1.445 × MELD ≥ 21 + 0.147 × Infection)

0.78

Model 10

h(t) = h₀(t)exp(0.036 × Age + 1.208 × DF ≥ 32 + 0.204 × Infection)

0.75

Model 11

h(t) = h₀(t)exp(0.034 × Age + 1.491 × MELD ≥ 21 + 0.401 × IR + 0.084 × Infection)

0.73

Model 12

h(t) = h₀(t)exp(0.036 × Age + 1.197 × DF ≥ 32 + 0.186 × IR + 0.175 × Infection)

0.73

Model 13

h(t) = h₀(t)exp(0.027 × Age + 1.191 × MELD ≥ 21 + 1.665 × Albumin < 3.5 + 0.315 × IR + 0.087 × Infection)

0.79

Model 14

h(t) = h₀(t)exp(0.031 × Age + 0.885 × DF ≥ 32 + 1.718 × Albumin < 3.5 + 0.118 × IR + 0.099 × Infection)

0.80