Formula
ABIC = (Age × 0.1)
+ (Bilirubin mg/dL × 0.08)
+ (Creatinine mg/dL × 0.3)
+ (INR × 0.8)
Unit conversions: Bilirubin μmol/L ÷ 17.1 = mg/dL; Creatinine μmol/L ÷ 88.4 = mg/dL
Interpretation
| ABIC Score | Risk Category | 90-Day Survival | Management |
|---|
| <6.71 |
Low |
~100% |
Standard care, alcohol cessation |
| 6.71–9.00 |
Intermediate |
~70% |
Consider steroids, nutritional support |
| >9.00 |
High |
~25% |
Steroids/pentoxifylline, early transplant evaluation |
Clinical Application
The ABIC Score is a baseline prognostic tool applied at the time of presentation with alcoholic hepatitis. Unlike the Lille Score — which assesses Day 7 response to corticosteroids — the ABIC Score stratifies initial risk and guides the intensity of workup and treatment planning.
- ABIC vs Maddrey DF: Complementary tools. Maddrey DF ≥32 is the classical threshold for deciding who to treat with corticosteroids. ABIC provides prognostic stratification across the full severity spectrum, including patients below the Maddrey DF threshold.
- ABIC vs Lille Score: ABIC is used at admission (Day 0) for prognosis; Lille is used at Day 7 to assess steroid response. Both are used together in the management of severe alcoholic hepatitis.
- High-risk ABIC (>9.0) + non-responder to steroids (Lille >0.45): This combination carries the highest mortality. Early liver transplant evaluation should be strongly considered in highly selected patients with a first episode of alcoholic hepatitis who do not respond to steroids.
- Nutritional support: Critical across all risk categories. Target 35–40 kcal/kg/day with 1.5 g/kg/day protein regardless of ABIC category.
- Alcohol cessation: The single most impactful long-term intervention. Multidisciplinary support (hepatology, addiction medicine, psychiatry) should be initiated at admission.
Validation
The ABIC Score was derived and validated in the original Dominguez 2008 study of 331 patients with biopsy-proven alcoholic hepatitis. It was compared head-to-head with Maddrey DF, Glasgow Alcoholic Hepatitis Score, and MELD score. Key findings:
- ABIC had superior discrimination for 90-day mortality compared with Maddrey DF (AUROC 0.82 vs 0.74)
- Three distinct risk groups were identified with clinically meaningful differences in 90-day and 1-year survival
- The score uses only four readily available biochemical parameters, making it practical in resource-limited settings
- Subsequent external validation studies have confirmed its utility, particularly in intermediate-risk patients where management decisions are most uncertain
Limitations
- Bilirubin units (mg/dL vs μmol/L) — unit conversion is critical; the calculator handles this automatically when the unit toggle is selected correctly
- Does not incorporate bilirubin trajectory over time (unlike the Lille Score, which captures Day 0 to Day 7 change)
- Does not account for encephalopathy, ascites, or infection — clinical context remains essential
- Derived from a biopsy-confirmed cohort; in clinical practice, diagnosis is often clinical without histological confirmation
References
- Dominguez M, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol. 2008;103(11):2747–2756.