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Gastroenterology. 2014 May;146(5):1231-9.e1-6. doi: 10.1053/j.gastro.2014.01.018. Epub 2014 Jan 15.

A histologic scoring system for prognosis of patients with alcoholic hepatitis.

Author information

  • 1Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
  • 2Pathology Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
  • 3Department of Morphology and Molecular Pathology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
  • 4Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
  • 5Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • 6Services d'Hepáto-Gastroentérologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France.
  • 7Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
  • 8UCL Institute of Hepatology, Royal Free Hospital, London, England.
  • 9Department of Pathology, Mayo Clinic, Rochester, Minnesota.
  • 10Institut de Pathologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France.
  • 11Liver Unit, Gastroenterology and Hepatology Division, Hospital General Universitario Gregorio Marañon, IISGM, School of Medicine, Universidad Complutense, CIBER de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
  • 12Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
  • 13Pathology Department, Hospital General Universitario Gregorio Marañon, IISGM, School of Medicine, Universidad Complutense, CIBER de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
  • 14Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
  • 15Division of Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
  • 16Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
  • 17Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: bataller@med.unc.edu.

Abstract

BACKGROUND & AIMS:

There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90-day) mortality.

METHODS:

We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 to January 2008 with features of AH and developed a histologic scoring system to determine the risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the United States and Europe, and a semiquantitative scoring system called the Alcoholic Hepatitis Histologic Score (AHHS) was developed. The system was validated in an independent set of 109 patients. Interobserver agreement was evaluated by weighted κ statistical analysis.

RESULTS:

The degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis, and presence of megamitochondria were independently associated with 90-day mortality. We used these 4 parameters to develop the AHHS to identify patients with a low (0-3 points), moderate (4-5 points), or high (6-9 points) risk of death within 90 days (3%, 19%, and 51%, respectively; P < .0001). The AHHS estimated 90-day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71-0.83). Interrater agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections.

CONCLUSIONS:

We identified histologic features associated with the severity of AH and developed a patient classification system that might be used in clinical decision making.

Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Alcoholic Hepatitis; Alcoholic Liver Disease; Histologic Classification; Liver Biopsy

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