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2014-01-15

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/128168

A histologic scoring system for prognosis of patients with Alcoholic hepatitis

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https://doi.org/10.1053/j.gastro.2014.01.018

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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.

Matèries

Hepatitis, Alcoholisme, Pronòstic mèdic, Malalties del fetge

Matèries (anglès)

Hepatitis, Alcoholism, Prognosis, Liver diseases

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Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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ALTAMIRANO, José, MIQUEL MORERA, Rosa, KATOONIZADEH, Aezam, ABRALDES, Juan g., DUARTE ROJO, Andrés, LOUVET, Alexandre, AUGUSTIN, Salvador, MOOKERJEE, Rajeshwar p., MICHELENA VEGAS, Xabier, 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, BAÑARES, Rafael, GINÈS I GIBERT, Pere, CABALLERIA ROVIRA, Joan, ROSKAMS, Tania, NEVENS, Frederick, JALAN, Rajiv, MATHURIN, Philippe, SHAH, Vijay h., BATALLER ALBEROLA, Ramón. A histologic scoring system for prognosis of patients with Alcoholic hepatitis. _Gastroenterology_. 2014. Vol. 146, núm. 5, pàgs. 1231-1239. [consulta: 24 de gener de 2026]. ISSN: 0016-5085. [Disponible a: https://hdl.handle.net/2445/128168]

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