Using consecutive liver biopsies constitutes an attractive approach to gaining insight into the pathogenesis of alcoholic liver disease.
Dr Mathurin and colleagues from France assessed a total of 193 drinkers who underwent consecutive biopsies at an interval of 4 years.
|Fibrosis score increased from 1 to 2|
|Alimentary Pharmacology & Therapeutics|
The research team analyzed histological factors at baseline, which are predictive of fibrosis progression and recurrence of alcoholic hepatitis.
At baseline, 20 patients had normal livers, 135 had steatosis, 5 had fibrosis and 33 had alcoholic hepatitis.
The fibrosis score increased from 1 to 2.
In multivariate analysis, the team found that steatosis, alcoholic hepatitis,
were independent predictive factors of the fibrosis score at the second biopsy.
The research team also observed that stage of fibrosis were independent predictive factors of the fibrosis score at the second biopsy.
The team found cirrhosis developed more frequently in patients with steatosis, and alcoholic hepatitis than in others.
Alcoholic hepatitis recurred more frequently in patients with alcoholic hepatitis at baseline.
The researchers found in multivariate analysis that alcoholic hepatitis at the first biopsy was the only predictive factor of its recurrence.
Dr Mathurin's team concluded, “In a large cohort of drinkers with consecutive biopsies, steatosis, fibrosis stage and alcoholic hepatitis at baseline were independent predictive factors of fibrosis progression.”
“In terms of mechanisms, we propose a novel concept of multiple hits of alcoholic hepatitis occurring in the same patient.”