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|Title:||A histologic scoring system for prognosis of patients with Alcoholic hepatitis|
Miquel Morera, Rosa
Abraldes, Juan G.
Duarte Rojo, Andrés
Mookerjee, Rajeshwar P.
Smyrk, Thomas C.
García Pagán, Juan Carlos
Guerrero Marquez, Carmen
Jones, Patricia D.
Barritt, A.S 4th.
Bruguera i Cortada, Miquel, 1942-
Ginès i Gibert, Pere
Shah, Vijay H.
Malalties del fetge
|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 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.|
|Note:||Versió postprint del document publicat a: https://doi.org/10.1053/j.gastro.2014.01.018|
|It is part of:||Gastroenterology, 2014, vol. 146, num. 5, p. 1231-1239|
|Appears in Collections:||Articles publicats en revistes (Medicina)|
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
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