ABIC Score for Alcoholic Hepatitis
Predicts short-term survival in patients with alcoholic hepatitis
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Why use it
Provides rapid risk stratification in alcoholic hepatitis to guide treatment decisions, ICU admission, and patient counseling. The inclusion of creatinine makes it superior to Maddrey's Discriminant Function in patients with hepatorenal syndrome or renal dysfunction. Validated in multiple international cohorts.
About
The ABIC score (Age, serum Bilirubin, INR, serum Creatinine) is a validated prognostic tool for predicting 90-day and 1-year survival in patients with alcoholic hepatitis. It was derived from a cohort of 97 patients and validated in an independent cohort. Unlike Maddrey's Discriminant Function, the ABIC score incorporates renal function (creatinine), which is a critical determinant of outcomes in alcoholic hepatitis. It classifies patients into three risk categories: low, intermediate, and high risk for 90-day mortality.
When to use
- Newly diagnosed alcoholic hepatitis requiring prognostic stratification
- Determining candidacy for corticosteroid therapy (Maddrey DF ≥ 32 combined with ABIC)
- Identifying patients at high risk who may need early liver transplant evaluation
- ICU admission triage for alcoholic hepatitis
- Monitoring treatment response when combined with the Lille model
Formula
Pearls & pitfalls
- ABIC uses the formula: Age × 0.1 + Serum Bilirubin × 0.08 + INR × 0.8 + Serum Creatinine × 0.3.
- The inclusion of creatinine reflects the importance of renal dysfunction (hepatorenal syndrome) in alcoholic hepatitis prognosis.
- An ABIC ≥ 9.0 identifies patients with ~25% 90-day survival — the highest-risk group.
- ABIC can be used alongside the Lille model (at day 7) to assess steroid response.
- Unlike MELD, ABIC was specifically derived and validated in alcoholic hepatitis patients.
- Corticosteroids (prednisolone 40 mg/day × 28 days) are the main treatment with ABIC-guided patient selection.
- The Lille model (day 7 response) should follow steroid initiation to confirm treatment efficacy.
Next steps
Low risk (ABIC < 6.71): Medical management with nutritional support, abstinence counseling. 90-day survival ~100%. Intermediate risk (6.71–8.99): Consider corticosteroids if Maddrey DF ≥ 32 and no contraindications; close monitoring. High risk (ABIC ≥ 9.0): Poor prognosis; consider pentoxifylline if steroids contraindicated; early liver transplant evaluation in selected abstinent patients; intensive supportive care.
Evidence
Dominguez M et al. (Hepatology 2008) derived and validated ABIC in 97 + 68 alcoholic hepatitis patients. At 90 days: low risk survival 100%, intermediate 70%, high risk 25%. Validated externally in multiple European and Asian cohorts. EASL guidelines on alcohol-related liver disease reference ABIC as a validated prognostic score.