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oai:recercat.cat:2445/1281682025-12-04T19:27:14Zcom_2072_1057col_2072_478858col_2072_478917col_2072_478921

A histologic scoring system for prognosis of patients with Alcoholic hepatitis Altamirano, José Miquel Morera, Rosa Katoonizadeh, Aezam Abraldes, Juan G. Duarte Rojo, Andrés Louvet, Alexandre Augustin, Salvador Mookerjee, Rajeshwar P. Michelena Vegas, Xabier Smyrk, Thomas C. Buob, David Leteurtre, Emmanuelle Rincón, Diego Ruiz, Pablo García Pagán, Juan Carlos Guerrero Marquez, Carmen Jones, Patricia D. Barritt, A.S 4th. Arroyo, Vicente Bruguera i Cortada, Miquel, 1942- Bañares, Rafael Ginès i Gibert, Pere Caballeria Rovira, Joan Roskams, Tania Nevens, Frederick Jalan, Rajiv Mathurin, Philippe Shah, Vijay H. Bataller Alberola, Ramón Hepatitis Alcoholisme Pronòstic mèdic Malalties del fetge Hepatitis Alcoholism Prognosis Liver diseases 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. 2019-02-12T12:50:48Z 2019-02-12T12:50:48Z 2014-01-15 2019-02-12T12:50:48Z info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion 0016-5085 https://hdl.handle.net/2445/128168 638865 24440674 eng Versió postprint del document publicat a: https://doi.org/10.1053/j.gastro.2014.01.018 Gastroenterology, 2014, vol. 146, num. 5, p. 1231-1239 https://doi.org/10.1053/j.gastro.2014.01.018 (c) AGA Institute, 2014 info:eu-repo/semantics/openAccess 22 p. application/pdf Elsevier Articles publicats en revistes (Medicina)