A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

José Altamirano; Rosa Miquel; Aezam Katoonizadeh; Juan G Abraldes; Andrés Duarte–Rojo; Alexandre Louvet; Salvador Augustin; Rajeshwar P Mookerjee; Javier Michelena; Thomas C Smyrk; David Buob; Emmanuelle Leteurtre; Diego Rincón; Pablo Ruiz; Juan Carlos García–Pagán; Carmen Guerrero–Marquez; Patricia D Jones; A. Sidney Barritt; Vicente Arroyo; Miquel Bruguera; Rafael Bañares; Pere Ginès; Juan Caballería; Tania Roskams; Frederik Nevens; Rajiv Jalan; Philippe Mathurin; Vijay H Shah; Ramón Bataller

doi:10.1053/j.gastro.2014.01.018

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A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

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A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

José Altamirano, Rosa Miquel, Aezam Katoonizadeh, Juan G Abraldes, Andrés Duarte–Rojo, Alexandre Louvet, Salvador Augustin, Rajeshwar P Mookerjee, Javier Michelena, Thomas C Smyrk, …

Gastroenterology (New York, N.Y. 1943), Vol.146(5), pp.1231-1239.e6

2014-05

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

PMCID: PMC3992184

PMID: 24440674

Abstract

Alcoholic Hepatitis

Liver Biopsy

Histologic Classification

Alcoholic Liver Disease

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. 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. 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. 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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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.100 Substance Abuse; 1.100.1013 Alcoholic Liver Disease
Web Of Science research areas: Gastroenterology & Hepatology
ESI research areas: Clinical Medicine

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Title: A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis
Creators: José Altamirano - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Rosa Miquel - Pathology Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Aezam Katoonizadeh - Department of Morphology and Molecular Pathology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
Juan G Abraldes - Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Andrés Duarte–Rojo - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Alexandre Louvet - Services d’Hepáto-Gastroentérologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France
Salvador Augustin - Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
Rajeshwar P Mookerjee - UCL Institute of Hepatology, Royal Free Hospital, London, England
Javier Michelena - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Thomas C Smyrk - Department of Pathology, Mayo Clinic, Rochester, Minnesota
David Buob - Institut de Pathologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France
Emmanuelle Leteurtre - Institut de Pathologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France
Diego Rincón - Liver Unit, Gastroenterology and Hepatology Division, Hospital General Universitario Gregorio Marañon, IISGM, School of Medicine, Universidad Complutense, CIBER de Enfermedades Hepáticas y Digestivas, Madrid, Spain
Pablo Ruiz - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Juan Carlos García–Pagán - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Carmen Guerrero–Marquez - Pathology Department, Hospital General Universitario Gregorio Marañon, IISGM, School of Medicine, Universidad Complutense, CIBER de Enfermedades Hepáticas y Digestivas, Madrid, Spain
Patricia D Jones - Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
A. Sidney Barritt - Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Vicente Arroyo - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Miquel Bruguera - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Rafael Bañares - Liver Unit, Gastroenterology and Hepatology Division, Hospital General Universitario Gregorio Marañon, IISGM, School of Medicine, Universidad Complutense, CIBER de Enfermedades Hepáticas y Digestivas, Madrid, Spain
Pere Ginès - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Juan Caballería - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Tania Roskams - Department of Morphology and Molecular Pathology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
Frederik Nevens - Division of Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
Rajiv Jalan - UCL Institute of Hepatology, Royal Free Hospital, London, England
Philippe Mathurin - Services d’Hepáto-Gastroentérologie, CHRU, Université de Lille, and Faculté de Médecine Pôle Recherche and INSERM Unite 837, Hôpital Huriez, Lille, France
Vijay H Shah - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Ramón Bataller - Liver Unit, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
Publication Details: Gastroenterology (New York, N.Y. 1943), Vol.146(5), pp.1231-1239.e6
Publisher: Elsevier Inc
Grant note: Fundación Banco Bilbao Vizcaya Argentaria PI080237; PS09/01164 / Fondo de Investigación Sanitaria National Institute on Alcohol Abuse 1U01AA021908-01; P30 DK 034987 / Alcoholism
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hepatology
Language: English
Resource Type: Journal article
PMID: 24440674
PMCID: PMC3992184
Record Identifier: 991031599031402976