An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study
Authors: Dunn Winston , Li Yanming , Singal Ashwani K. , Simonetto Douglas A. , Díaz Luis A. , Idalsoaga Francisco , Ayares Gustavo , Arnold Jorge , Ayala-Valverde María , Perez Diego , Gomez Jaime , Escarate Rodrigo , Fuentes-López Eduardo , Ramirez-Cadiz Carolina , Morales-Arraez Dalia , Zhang Wei , Qian Steve , Ahn Joseph C. , Buryska Seth , Mehta Heer , Dunn Nicholas , Waleed Muhammad , Stefanescu Horia , Bumbu Andreea , Horhat Adelina , Attar Bashar , Agrawal Rohit , Cabezas Joaquín , Echavaría Victor , Cuyàs Berta , Poca Maria , Soriano German , Sarin Shiv K. , Maiwall Rakhi , Jalal Prasun K. , Higuera-de-la-Tijera Fátima , Kulkarni Anand V. , Rao P. Nagaraja , Guerra-Salazar Patricia , Skladaný Lubomir , Kubánek Natália , Prado Veronica , Clemente-Sanchez Ana , Rincon Diego , Haider Tehseen , Chacko Kristina R. , Romero Gustavo A. , Pollarsky Florencia D. , Restrepo Juan C. , Toro Luis G. , Yaquich Pamela , Mendizabal Manuel , Garrido Maria L. , Marciano Sebastián , Dirchwolf Melisa , Vargas Victor , Jiménez César , Hudson David , García-Tsao Guadalupe , Ortiz Guillermo , Abraldes Juan G. , Kamath Patrick S. , Arrese Marco , Shah Vijay H. , Bataller Ramon , Arab Juan Pablo 
Published: April 2024

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/.