Altamirano, J; Miquel, R; Katoonizadeh, A; Abraldes, JG; Duarte-Rojo, A; Louvet, A; Augustin, S; ... Bataller, R; + view all Altamirano, J; Miquel, R; Katoonizadeh, A; Abraldes, JG; Duarte-Rojo, A; Louvet, A; Augustin, S; Mookerjee, RP; Michelena, J; Smyrk, TC; Buob, D; Leteurtre, E; Rincón, D; Ruiz, P; García-Pagán, JC; Guerrero-Marquez, C; Jones, PD; Barritt, AS; Arroyo, V; Bruguera, M; Bañares, R; Ginès, P; Caballería, J; Roskams, T; Nevens, F; Jalan, R; Mathurin, P; Shah, VH; Bataller, R; - view fewer (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.

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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.

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