4.8 Article

A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

期刊

GASTROENTEROLOGY
卷 146, 期 5, 页码 1231-+

出版社

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2014.01.018

关键词

Alcoholic Hepatitis; Alcoholic Liver Disease; Histologic Classification; Liver Biopsy

资金

  1. Fondo de Investigacion Sanitaria [FIS PI080237, FIS PS09/01164]
  2. National Institute on Alcohol Abuse and Alcoholism grants [1U01AA021908-01, P30 DK 034987]
  3. Fundacion Banco Bilbao Vizcaya Argentaria
  4. Ministerio de Educacion de Espana [FPU 11-2607]
  5. Instituto de Salud Carlos III [FIS PI11/0883]
  6. FEDER funds (EU, Una manera de hacer Europa)
  7. Instituto de Salud Carlos III, Madrid, Spain
  8. [P30DK084567]
  9. [AA021788]

向作者/读者索取更多资源

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 kappa 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.

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