Altamirano, JoséMiquel Morera, RosaKatoonizadeh, AezamAbraldes, Juan G.Duarte Rojo, AndrésLouvet, AlexandreAugustin, SalvadorMookerjee, Rajeshwar P.Michelena Vegas, XabierSmyrk, Thomas C.Buob, DavidLeteurtre, EmmanuelleRincón, DiegoRuiz, PabloGarcía Pagán, Juan CarlosGuerrero Marquez, CarmenJones, Patricia D.Barritt, A.S 4th.Arroyo, VicenteBruguera i Cortada, Miquel, 1942-Bañares, RafaelGinès i Gibert, PereCaballeria Rovira, JoanRoskams, TaniaNevens, FrederickJalan, RajivMathurin, PhilippeShah, Vijay H.Bataller Alberola, Ramón2019-02-122019-02-122014-01-150016-5085https://hdl.handle.net/2445/128168BACKGROUND & 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.22 p.application/pdfeng(c) AGA Institute, 2014HepatitisAlcoholismePronòstic mèdicMalalties del fetgeHepatitisAlcoholismPrognosisLiver diseasesinfo:eu-repo/semantics/article6388652019-02-12info:eu-repo/semantics/openAccess24440674