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Prognostic Role of Liver Biopsy in Patients With Severe Indeterminate Acute Hepatitis

Lin, S; Araujo, C; Hall, A; Kumar, R; Phillips, A; Hassan, M; Engelmann, C; ... Jalan, R; + view all (2022) Prognostic Role of Liver Biopsy in Patients With Severe Indeterminate Acute Hepatitis. Clinical Gastroenterology and Hepatology , 20 (5) 1130-1141.e7. 10.1016/j.cgh.2021.08.008. Green open access

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Abstract

Background and Aims: Severe indeterminate acute hepatitis (sIAH) is a poorly understood rare disease with no specific therapy. This study aims to define the clinicopathological characteristics of sIAH and the role of liver biopsy in determining prognosis. / Methods: Patients with sIAH admitted to a single center between 2010 and 2019 were included. Histopathological patterns of liver biopsies were reviewed by 2 histopathologists, and key findings further were specified by multiplex immunofluorescence. Patients that died or underwent liver transplantation were analyzed as nonsurvivors. / Results: Of 294 patients with acute hepatitis, 43 with sIAH were included. Seventeen (39.5%) underwent liver transplantation and 7 (16.2%) died within 3 months. Multilobular necrosis was the predominant histopathological feature, being significantly more frequent in nonsurvivors (62.5% vs 21.1%; P = .016). Necrotic areas showed low HNF4α and Ki67 expression but high expression of CK19 and cell death markers identifying areas of severe tissue injury and inadequate regenerative response. Patients with multilobular necrosis had higher international normalized ratio, Model for End-Stage Liver Disease, and Model for End-Stage Liver Disease-Sodium scores compared with those without (P values for all markers <.05). Multivariate Cox analysis revealed that multilobular necrosis (hazard ratio, 3.675; 95% confidence interval, 1.322–10.211) and lower body mass index (hazard ratio, 0.916; 95% confidence interval, 0.848–0.991) independently predicted death or transplantation. / Conclusions: The results of this study provide novel insights into the important role of liver biopsy in sIAH patients, suggesting that the presence of multilobular necrosis is an early indicator of poor prognosis.

Type: Article
Title: Prognostic Role of Liver Biopsy in Patients With Severe Indeterminate Acute Hepatitis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.cgh.2021.08.008
Publisher version: http://dx.doi.org/10.1016/j.cgh.2021.08.008
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Indeterminate Hepatitis, Histopathology, Multiplex Immunofluorescence
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10134208
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