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Multicenter Study
. 2014 May;146(5):1231-9.e1-6.
doi: 10.1053/j.gastro.2014.01.018. Epub 2014 Jan 15.

A histologic scoring system for prognosis of patients with alcoholic hepatitis

José Altamirano  1 , Rosa Miquel  2 , Aezam Katoonizadeh  3 , Juan G Abraldes  4 , Andrés Duarte-Rojo  5 , Alexandre Louvet  6 , Salvador Augustin  7 , Rajeshwar P Mookerjee  8 , Javier Michelena  1 , Thomas C Smyrk  9 , David Buob  10 , Emmanuelle Leteurtre  10 , Diego Rincón  11 , Pablo Ruiz  1 , Juan Carlos García-Pagán  12 , Carmen Guerrero-Marquez  13 , Patricia D Jones  14 , A Sidney Barritt 4th  14 , Vicente Arroyo  1 , Miquel Bruguera  1 , Rafael Bañares  11 , Pere Ginès  1 , Juan Caballería  1 , Tania Roskams  3 , Frederik Nevens  15 , Rajiv Jalan  8 , Philippe Mathurin  6 , Vijay H Shah  16 , Ramón Bataller  17
Affiliations
Multicenter Study

A histologic scoring system for prognosis of patients with alcoholic hepatitis

José Altamirano et al. Gastroenterology. 2014 May.

Abstract

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.

Keywords: Alcoholic Hepatitis; Alcoholic Liver Disease; Histologic Classification; Liver Biopsy.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors disclose no conflicts.

Figures

Figure 1
Figure 1
Histological Features Independently Associated with 90-day Survival Included in the Alcoholic Hepatitis Histological Score (AHHS). A, B and C) Degree of fibrosis (Masson’s Trichrome staining); portal fibrosis, expansive areas of liver fibrosis and cirrhosis, respectively. Photomicrographs A, B and C: Hematoxylin and eosin staining.
Figure 2
Figure 2
Histological Features Independently Associated with 90-day Survival Included in the Alcoholic Hepatitis Histological Score (AHHS). A) Hepatocellular and canalicular bilirubinostasis (arrow). B) Ductular bilirubinostasis (arrow). C) Megamitochondria (arrows). D and E) Mild and severe PMN infiltration, respectively. Photomicrographs A–D and E: Hematoxylin and eosin staining; PNM: Polymorphonuclear cells.
Figure 3
Figure 3
Three-month Survival Probability of Patients with Alcoholic Hepatitis According to the Alcoholic Hepatitis Histological Score (AHHS) in the study (a) and validation (b) cohorts.
Figure 4
Figure 4
a) Three-month survival probability in patients with ABIC B according to the Alcoholic Hepatitis Histological Score. a) Three-month survival probability in patients with MELD <21 according to the Alcoholic Hepatitis Histological Score
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