TY - JOUR
T1 - A histologic scoring system for prognosis of patients with alcoholic hepatitis
AU - Altamirano, José
AU - Miquel, Rosa
AU - Katoonizadeh, Aezam
AU - Abraldes, Juan G.
AU - Duarte-Rojo, Andrés
AU - Louvet, Alexandre
AU - Augustin, Salvador
AU - Mookerjee, Rajeshwar P.
AU - Michelena, Javier
AU - Smyrk, Thomas C.
AU - Buob, David
AU - Leteurtre, Emmanuelle
AU - Rincón, Diego
AU - Ruiz, Pablo
AU - García-Pagán, Juan Carlos
AU - Guerrero-Marquez, Carmen
AU - Jones, Patricia D.
AU - Barritt, A. Sidney
AU - Arroyo, Vicente
AU - Bruguera, Miquel
AU - Bañares, Rafael
AU - Ginès, Pere
AU - Caballería, Juan
AU - Roskams, Tania
AU - Nevens, Frederik
AU - Jalan, Rajiv
AU - Mathurin, Philippe
AU - Shah, Vijay H.
AU - Bataller, Ramón
N1 - Funding Information:
Funding Supported by grants from Fondo de Investigación Sanitaria (FIS PI080237 and FIS PS09/01164 to R.B. and J.C.) and by National Institute on Alcohol Abuse and Alcoholism grants 1U01AA021908-01 and P30 DK 034987 . J.A. is the recipient of a grant from Fundación Banco Bilbao Vizcaya Argentaria and is enrolled in the Master on Research in Liver Diseases and PhD program of the Universitat de Barcelona. J.M. is the recipient of grant FPU 11-2607 from Ministerio de Educación de España and is enrolled in the Master on Research in Liver Diseases of the Universitat de Barcelona. J.G.A. is the recipient of a grant from Instituto de Salud Carlos III (FIS PI11/0883), cofinanced by FEDER funds (EU, “Una manera de hacer Europa”). Mayo tissue collections were performed through grants P30DK084567 and AA021788. S.A. is a recipient of a Juan Rodés grant by Instituto de Salud Carlos III, Madrid, Spain.
PY - 2014/5
Y1 - 2014/5
N2 - 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.
AB - 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.
KW - Alcoholic Hepatitis
KW - Alcoholic Liver Disease
KW - Histologic Classification
KW - Keywords
KW - Liver Biopsy
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U2 - 10.1053/j.gastro.2014.01.018
DO - 10.1053/j.gastro.2014.01.018
M3 - Article
C2 - 24440674
AN - SCOPUS:84899409476
SN - 0016-5085
VL - 146
SP - 1231-1239.e6
JO - Gastroenterology
JF - Gastroenterology
IS - 5
ER -