There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis.
Dr Ramón Bataller and colleagues from Spain identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90-day) mortality.
The research team analyzed data from 121 patients admitted to the Liver Unit from 2000 to 2008 with features of alcoholic hepatitis, 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.
|The AHHS estimated 90-day mortality in the training and test sets with an AUROC of 0.77|
Interobserver agreement was evaluated by weighted κ statistical analysis.
The team found that the degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis, and presence of megamitochondria were independently associated with 90-day mortality.
The research team 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.
The AHHS estimated 90-day mortality in the training and test sets with an area under the receiver operating characteristic (AUROC) value of 0.77.
The team found that 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.
Dr Bataller's team comments, "We identified histologic features associated with the severity of alcoholic hepatitis and developed a patient classification system that might be used in clinical decision making."