INTRODUCTION Patients with Alcoholic hepatitis AH experience far

INTRODUCTION • Patients with Alcoholic hepatitis (AH) experience far higher mortality rates and undergo a series of symptoms consistent with acute-on-chronic liver failure. • Different metrics for prognostication of outcome in AH patients; however, none of these values have high specificity and sensitivity, likely due to the complex nature of AH. • FL-Keratin-18 = M 65 • C-Keratin-18 = M 30 • The ratio between M 30 and M 65 has been used as metric of cell death in both humans and in animal models. • Both M 65 and M 30 fragments have fairly long half lives in vivo that give a wider analytical window for detecting rapid processes, particularly apoptosis. • Modification of other metrics with M 65 or M 30 values can enhance predictive capacity of other prognostic metrics in liver diseases. • K 18 is a known component of Mallory bodies present in patients with alcoholic cirrhosis, there are no current studies that have investigated plasma M 65 or M 30 levels in the context of a clinical diagnosis, despite the fact that apoptotic cells are typically found in AH livers.

• We hypothesized that plasma M 65 and M 30 values would be elevated enough to potentially distinguish alcoholic cirrhosis from AH, and potentially predict outcome in these patients. • Surprisingly, M 65 and M 30 levels were dramatically and substantially elevated in both AC and AH patients and had significant clinical value in predicting short-term mortality (30 days) in AH patients. • Even still, these values correlated poorly with traditional plasma parameters of liver cell death, and may be related to other, as of yet unknown pathologies that occur during AH.

Using the variables available at admission (Age, serum Bilirubin, INR and serum Creatinine), a new score (ABIC score) was generated from the sum of natural logarithms (ln) of HR multiplied by each variable ([age in years times ln 1. 11]+ [ bilirubin in mg/d. L times ln 1. 08]+ [ creatinine in mg/d. L times ln 1. 31]+ [ INR times ln 2. 13]). The resulting score was: [(age times 0. 1) + (serum bilirubin times 0. 08) + (serum creatinine times 0. 3) + (INR times 0. 8)]. The values obtained ranged from 4. 9 to 12. 26.