Table 3-1Summary of included studies

Study, number of biopsiesRationalePrebiopsy diagnosisFinal diagnosis (alcohol-related only)Patient PopulationComparison
Alcoholic liver disease
ELPHICK 200776

Level 1b++

N=110
Reported on the histological features suggestive of ALD in patients with presumed decompensated ALD110/110 (100%) decompensated ALD104/110 (95%) decompensated ALD

78/110 (71%) had cirrhosis
Patients with presumed decompensated ALD defined as Child’s Grade B or C, consumption of at least 60 units of alcohol per week (men) or 40 units/week (females) for at least 5 yrs prior to the episode of decompensation, no other liver disease on extensive noninvasive workupHistological features of ALD: fatty infiltration, a neutrophil infiltrate, ballooning hepatocyte degeneration, and Mallory’s hyaline
VAN NESS 198981

Level 1b+

N=90
Reported on the diagnostic accuracy of diagnosis made before biopsy on the basis of non-invasive work-up (history, physical examination, laboratory values and imaging) and a final diagnosis made after biopsy for alcoholic liver disease26/90 (29%)ALD: alcoholic steatosis 2/26 (8%), 12/26 (46%) mild alcoholic liver disease, 2/26 (8%) moderate alcoholic liver disease, 10/26 (38%) alcoholic cirrhosis

19/90 fatty liver, 25/90 chronic necroinflammatory disease, 20/90 Misc
23/90 (26%) alcoholic liver disease: 7/23 alcoholic cirrhosis, 5/23 alcoholic hepatitis with fibrosis, 4/23 alcoholic hepatitis without firbrosis, alcoholic foamy degeneration 2/23, alcoholic siderosis 1/23Patients with elevated liver associated enzymes. Patients with previously undiagnosed liver disease were included if at least one liver-associated enzyme (asparate aminotransferase (AST), alkaline phosphatase (AP), alanine aminotranferase (ALT), gamma glutamyl transpeptidase (GGT)) was elevated to 1.5 times the upper limit of normal for 3 months or morePre-biopsy (clinical diagnosis

The complete blood count, platelet count, prothrombin time and partial thromboplastine time were measured within 3 days before the biopsy
TALLEY 198880

Level 1b+

N=108
Clinical diagnosis recorded before biopsy was compared with the histological diagnosis of an experienced histopathologist.35/108 (32%) ALD

73/108 (78%) non-ALD
25/108 (23%) alcoholic liver disease: 25/35 (71%) with a prebiopsy diagnosis had a final diagnosis of ALD: cirrhosis 14/25 (56%), cirrhosis and alcoholic hepatitis 1/25 (4%), alcoholic hepatitis 6/25 (24%), 1/25 (4%) fibrosis and lipogranulomasAll patients who underwent liver biopsy regardless of their alcohol intake. All patients had prebiopsy diagnosis of hepatic disease and undergoing biopsy for the first time. Of these, 35/108 (32%) had a prebiopsy diagnosis of ALD and 73/108 (68%) non-ALDClinical diagnosis

Included: Bilirubin, alanine aminotransferase (ALT), aspirate aminotransferase (AST), gamma glutamyltransferase (GGT), serum alkaline phosphatise, albumin
Alcoholic hepatitis/cirrhosis
KRYGER 198379

Level 1b++

N=357
Patients who had undergone liver biopsy. Clinicians reviewed the case histories without knowledge of the biopsy results.200/357 (56%) had a history of alcoholism172/357 (48%) alcohol-induced changes: 80/357 (22%) alcoholic cirrhosis, 84/357 (26%) steatosis, 8/357 (2%) alcoholic hepatitis without cirrhosisPatients who had undergone liver biopsyAnamnestic, clinical and biochemical findings
THABUT 200677

Level 1b++

N=225
Diagnostic accuracy of a panel of biomarkers (AshTest) for the diagnosis of alcoholic hepatitis in patients with alcoholic liver disease. The results were compared with those obtained from using Maddrey discriminant function ≥ 32 and the AST:ALT ratioDiagnosis based on biopsy
Cirrhosis:
Training group 57/70 (81%)

Validation group 1: 56/62 (90%)

Validation group 2: 23/93 (25%)

Alcoholic hepatitis features:
Necrosis and polynuclear neutrophils:
Training group 42/70 (60%)

Validation group 1 12/62 (19%)

Validation group 2 22/93 (24%)
At least one hepatitis feature:
Training group 61/70 (87%)

Validation group 1 32/62 (52%)

Validation group 2 65/93 (70%)
Patients with an alcohol intake >50 g/d with available serum and liver biopsyAshTest:

AST, total bilirubin, GGT, macroglobulin, Apo A1, haptoglobin
VANBIERVLIET 200678

Level 1b++

N=104
Reported on the diagnostic accuracy of CRP for alcoholic hepatitis in heavy drinkers55/101 (55%) mild fibrosis, 46/101 (45%) significant liver fibrosis20/104 (19.8%) cirrhosis

29/104 (30%) acute alcoholic hepatitis
Patients admitted to a liver unit for detoxification and evaluationC-Reactive Protein (CRP)
GOLDBERG 198682

Level 1b+

N=89
Patients with clinically mild biopsy-proven alcoholic hepatitis were followed-up for ≥ 30 months. The diagnostic accuracy of laboratory tests for cirrhosis was reported89/89 (100%) mild biopsy-proven alcoholic hepatitis34/89 (38%) cirrhosisPatients with biopsy-proven alcoholic hepatitis and ‘seemingly’ mild (bilirubin ≤ 5 mg/dl) liver disease. An alcoholic was defined as a history of consuming more than 80 g/day of ethanol during the preceding year. Any alcoholic with a history of recent drug abuse or the presence of HBsAg was excludedThe step-wise logistic discriminant analysis identified IgA, prothrombin time and SGOT/SGPT ratio (in order of importance) as the best predictors of cirrhosis

Final model of discriminate function (DF) was derived to predict the probability of being cirrhotic, where DF = 0.606 (SGOT/SGPT) + 9.43 (IgA), with IgA expressed as g/dl
KITADAI 198584

Level 1b+

N=67
Diagnostic accuracy of age, total alcohol intake, hepatomegaly and 12 liver function tests for biopsy-proven alcoholic liver cirrhosis and hepatitisDiagnosis based on biopsy: 37/67 (55%) alcoholic liver cirrhosis, 14/67 (24%) alcoholic hepatitis, 7/67 (9%)Patients classified at habitual drinkers with liver injury; all presented history of daily alcohol consumption of more than 90 ml ethanol equivalents per day for over 5 yrsAge, total alcohol intake, hepatomegaly and 12 liver function tests
IRELAND 199183

Level 2+

N=117
Review of patients with suspected alcoholic liver disease who had undergone biopsy. Patients were grouped into those with raised GGT, raised GGT, increased AST activity with or without raised GGT or widespread abnormal liver function testsRaised GGT 17/117 (15%)

Raised AST and GGT 34/117 (29%)

Widespread abnormal results 66/117 (56%)
17/117 (14.5%) cirrhosis

18/117 (15%) hepatitis
Patients with suspected alcoholic liver diseaseRaised GGT

Raised AST and GGT

Widespread abnormal results

From: 3, Alcohol-related liver disease

Cover of Alcohol Use Disorders
Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet].
NICE Clinical Guidelines, No. 100.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guidelines Centre.

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