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Title: A histologic scoring system for prognosis of patients with Alcoholic hepatitis
Author: Altamirano, José
Miquel Morera, Rosa
Katoonizadeh, Aezam
Abraldes, Juan G.
Duarte Rojo, Andrés
Louvet, Alexandre
Augustin, Salvador
Mookerjee, Rajeshwar P.
Michelena, Javier
Smyrk, Thomas C.
Buob, David
Leteurtre, Emmanuelle
Rincón, Diego
Ruiz, Pablo
García Pagán, Juan Carlos
Guerrero Marquez, Carmen
Jones, Patricia D.
Barritt, A.S 4th.
Arroyo, Vicente
Bruguera i Cortada, Miquel, 1942-
Bañares, Rafael
Ginès i Gibert, Pere
Caballeria Rovira, Joan
Roskams, Tania
Nevens, Frederick
Jalan, Rajiv
Mathurin, Philippe
Shah, Vijay H.
Bataller Alberola, Ramón
Keywords: Hepatitis
Pronòstic mèdic
Malalties del fetge
Liver diseases
Issue Date: 15-Jan-2014
Publisher: Elsevier
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:
It is part of: Gastroenterology, 2014, vol. 146, num. 5, p. 1231-1239
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ISSN: 0016-5085
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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