Evidence mapPaperPMID 42572151Full record

ArticleAlcohol, clinical & experimental research2026

Short-Term Risk Stratification in Alcohol-Associated Hepatitis: Small HDL Particles and Inflammation Vulnerability Index Values Improve Model for End-Stage Liver Disease.

Eduardo Vilar-Gomez, Margery A Connelly, Vijay H Shah, Irina Shalaurova, Jill M Rafalko, Arun J Sanyal, Naga P Chalasani, Samer Gawrieh, TREAT Consortium

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Article in Alcohol, clinical & experimental research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Eduardo Vilar-GomezDivision of Gastroenterology & Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0003-1435-4013
Margery A ConnellyLabcorp, Morrisville, North Carolina, USA.ORCID https://orcid.org/0000-0002-3917-592X
Vijay H ShahDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Irina ShalaurovaLabcorp, Morrisville, North Carolina, USA.
Jill M RafalkoLabcorp, Morrisville, North Carolina, USA.ORCID https://orcid.org/0000-0003-3241-9781
Arun J SanyalDivision of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA.ORCID https://orcid.org/0000-0001-8682-5748
Naga P ChalasaniDivision of Gastroenterology & Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0003-4082-3178
Samer GawriehDivision of Gastroenterology & Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0002-2056-4909
TREAT Consortium

Funding

NIAAA NIH HHS 2U24AA026969-06NIAAA NIH HHS 5U01AA021788-04NIAAA NIH HHS 5U01AA021840-04NIAAA NIH HHS 5U01AA021883-04NIAAA NIH HHS 5U01AA021891-04
6 · The paper itself

Abstract

backgroundAlcohol-associated hepatitis (AH) has high short-term mortality, whereas current prognostic models mainly reflect liver and renal dysfunction. The Metabolic Vulnerability Index (MVX) is a nuclear magnetic resonance-derived score comprising the Inflammation Vulnerability Index (IVX; small high-density lipoprotein particles [S-HDL-P] and GlycA) and the Metabolic Malnutrition Index (MMX). We evaluated whether MVX, IVX, and IVX components improve 90-day mortality prediction beyond Model for End-Stage Liver Disease (MELD) in AH.

methodsSerum samples from 196 patients with AH, 169 heavy-drinking controls, and 351 healthy controls were analyzed by nuclear magnetic resonance spectroscopy. The primary outcome was 90-day AH-related mortality. Biomarkers were modeled continuously after standardization within the AH cohort; S-HDL-P was modeled per 1 SD decrease. Cox models were adjusted for MELD, age, sex, white blood cell count, and baseline antibiotic or corticosteroid use. Model performance was assessed using Akaike information criterion (AIC), likelihood-ratio testing, and Harrell's C-statistic.

resultsAmong patients with AH, 30 AH-related deaths occurred within 90 days (15.3%). IVX and MVX were highest in AH cases and increased with AH severity, whereas MMX did not consistently differentiate severity. Lower S-HDL-P was independently associated with 90-day mortality in fully adjusted models (HR, 1.84; 95% CI, 1.01-3.35; p = 0.045), whereas GlycA was not (HR, 0.86; 95% CI, 0.54-1.37; p = 0.527). Adding S-HDL-P improved fully adjusted MELD-based model fit (AIC, 298.97 vs. 301.46; LR p = 0.034; C-statistic, 0.741 vs. 0.729). IVX showed supportive improvement in model fit and discrimination (AIC, 299.81; LR p = 0.056; C-statistic, 0.749). Continuous MELD interaction analyses supported risk separation for S-HDL-P (LR χ

conclusionsLower S-HDL-P appears to be the principal short-term prognostic component within the IVX domain in AH. S-HDL-P and IVX may refine MELD-based 90-day risk stratification, pending external validation.

Indexed as

End Stage Liver DiseaseHepatitis, AlcoholicInflammationLipoproteins, HDLAdultAgedBiomarkersFemaleHumansMaleMiddle AgedPrognosisRisk AssessmentBiomarkersLipoproteins, HDLalcohol‐associated hepatitisinflammation vulnerability indexliver diseasemetabolic malnutritionnuclear magnetic resonance spectroscopyshort‐term mortality

Identifiers

PMID42572151
PMCPMC13454315

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.