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A histologic scoring system for prognosis of patients with alcoholic hepatitis

Altamirano, J; Miquel, R; Katoonizadeh, A; Abraldes, JG; Duarte-Rojo, A; Louvet, A; Augustin, S; ... Bataller, R; + view all (2014) A histologic scoring system for prognosis of patients with alcoholic hepatitis. Gastroenterology , 146 (5) pp. 1231-1239. 10.1053/j.gastro.2014.01.018. Green open access

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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 through January 2008 with features of AH, and developed a histologic scoring system to determine 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 US and Europe, and a semi-quantitative scoring system was developed, called the alcoholic hepatitis histologic score (AHHS). The system was validated in an independent set of 109 patients. Inter-observer agreement was evaluated by weighted statistic analysis. Results: Degree of fibrosis, neutrophil infiltration, type of bilirubinostasis, and presence mega-mitochondria were independently associated with 90 day mortality. We used these 4 parameters to develop the AHHS to identify patients with low (0–3 points), moderate (4–5 points), and high (6–9 points) risks 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). Inter-rate 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 severity of AH and developed a patient classification system that might be used in clinical decision making.

Type: Article
Title: A histologic scoring system for prognosis of patients with alcoholic hepatitis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1053/j.gastro.2014.01.018
Publisher version: http://dx.doi.org/10.1053/j.gastro.2014.01.018
Language: English
Keywords: Alcoholic Hepatitis, Alcoholic Liver Disease, Histologic Classification, Liver Biopsy, Adult, Bilirubin, Biopsy, Chi-Square Distribution, Decision Support Techniques, Europe, Female, Hepatitis, Alcoholic, Humans, Kaplan-Meier Estimate, Liver, Liver Cirrhosis, Logistic Models, Male, Middle Aged, Mitochondria, Liver, Mitochondrial Size, Multivariate Analysis, Neutrophil Infiltration, Observer Variation, Odds Ratio, Predictive Value of Tests, Prognosis, Reproducibility of Results, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, United States
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 > 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/1434847
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