OBJECTIVES Severe alcoholic hepatitis (sAH) confers substantial mortality, but the disease course is difficult to predict. As iron parameters are attractive outcome predictors in other liver diseases, we tested their prognostic ability in sAH. METHODS Serum ferritin, transferrin, iron, transferrin saturation, nontransferrin-bound iron, soluble transferrin receptor, and hepcidin were measured in 828 patients with sAH recruited prospectively through the STOPAH trial. The cohort was randomly divided into exploratory (n = 200) and validation sets (n = 628). RESULTS Patients with sAH had diminished serum transferrin but increased transferrin saturation. Among iron parameters, baseline transferrin was the best predictor of 28-day (area under the receiver operated characteristic 0.72 [95% confidence interval 0.67-0.78]) and 90-day survival (area under the receiver operated characteristic 0.65 [0.61-0.70]). Transferrin's predictive ability was comparable with the composite scores, namely model of end-stage liver disease, Glasgow alcoholic hepatitis score, and discriminant function, and was independently associated with survival in multivariable analysis. These results were confirmed in a validation cohort. Transferrin did not correlate with markers of liver synthesis nor with non-transferrin-bound iron or soluble transferrin receptor (as markers of excess unbound iron and functional iron deficiency, respectively). DISCUSSION In patients with sAH, serum transferrin predicts mortality with a performance comparable with commonly used composite scoring systems. Hence, this routinely available parameter might be a useful marker alone or as a component of prognostic models.

中文翻译：

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血清转铁蛋白是严重酒精性肝炎死亡率的独立预测因子

目标 严重酒精性肝炎 (sAH) 会导致大量死亡率，但病程难以预测。由于铁参数是其他肝病的有吸引力的结果预测因子，我们测试了它们在 sAH 中的预后能力。方法 对通过 STOPAH 试验前瞻性招募的 828 名 sAH 患者的血清铁蛋白、转铁蛋白、铁、转铁蛋白饱和度、非转铁蛋白结合铁、可溶性转铁蛋白受体和铁调素进行测量。该队列被随机分为探索性（n = 200）和验证集（n = 628）。结果 sAH 患者的血清转铁蛋白减少，但转铁蛋白饱和度增加。在铁参数中，基线转铁蛋白是 28 天（接受者操作特征下面积 0.72 [95% 置信区间 0.67-0. 78]）和 90 天生存期（接受者操作特征下的面积 0.65 [0.61-0.70]）。转铁蛋白的预测能力与综合评分（即终末期肝病模型、格拉斯哥酒精性肝炎评分和判别功能）相当，并且在多变量分析中与生存率独立相关。这些结果在验证队列中得到证实。转铁蛋白与肝脏合成标志物或非转铁蛋白结合铁或可溶性转铁蛋白受体（分别作为过量未结合铁和功能性缺铁的标志物）无关。讨论 在 sAH 患者中，血清转铁蛋白可以预测死亡率，其性能与常用的综合评分系统相当。因此，