Presence of alcoholic steatohepatitis, but no selective histological feature, indicates an increased risk of cirrhosis and premature death

Abstract

Presence of steatohepatitis indicates an increased risk of cirrhosis and premature death. However, none of the histological parameters defining steatohepatitis can independently identify patients at risk for premature death.

Extra‐hepatic morbidity and mortality in alcohol‐related liver disease: Systematic review and meta‐analysis

“…Of the 37 included studies, seven (including 15 204 participants) reported outcomes in AFLD, five studies (2541 participants) described outcomes in AH, 10,18,27,33,35 thirteen studies (15 302 participants) described outcomes in cirrhosis, 21–24,29,31,34,36,38,39,42,43,45 four studies (635 participants) described outcomes in decompensated cirrhosis 11–13,25 and a further 11 studies (18 866 participants) reported outcomes for ALD as a single entity 14,17,21,26,28,30,32,34,37,40,44 . Sixteen studies (6265 participants) 16,18–21,26–30,36,37,41,45–47 defined subgroups of ALD through biopsy, six studies (1642 participants) used a combination of biopsy and clinical diagnosis, 12,14,31,32,34,43 and 15 studies (42 395 participants) reported outcomes in patients diagnosed clinically 11,13,15,17,22–25,33,35,38–40,42,44 . Two further studies reported on patients with histological steatohepatitis (169 participants), but not necessarily the clinical syndrome of AH 19,41 and were considered separately.…”

“…Of the 37 included studies, seven (including 15 204 participants) reported outcomes in AFLD, five studies (2541 participants) described outcomes in AH, 10,18,27,33,35 thirteen studies (15 302 participants) described outcomes in cirrhosis, [21][22][23][24]29,31,34,36,38,39,42,43,45 four studies (635 participants) described outcomes in decompensated cirrhosis [11][12][13]25 and a further 11 studies (18 866 participants) reported outcomes for ALD as a single entity. 14,17,21,26,28,30,32,34,37,40,44 Sixteen studies (6265 participants) 16,[18][19][20][21][26][27][28][29][30]36,37,41,[45][46]…”

“…14,17,21,26,28,30,32,34,37,40,44 Sixteen studies (6265 participants) 16,[18][19][20][21][26][27][28][29][30]36,37,41,[45][46][47] defined subgroups of ALD through biopsy, six studies (1642 participants) used a combination of biopsy and clinical diagnosis, 12,14,31,32,34,43 and 15 studies (42 395 participants) reported outcomes in patients diagnosed clinically. 11,13,15,17,[22][23][24][25]33,35,[38][39][40]42,44 Two further studies reported on patients with histological steatohepatitis (169 participants), but not necessarily the clinical syndrome of AH 19,…”

“…Five studies (including 2541 participants) reporting patients with clinical AH 10,18,27,33,35 were compared to two studies (169 participants) reporting histological steatohepatitis. 19,41 The risk of liver-related mortality was greater in patients with clinically diagnosed AH (RD 0.32, 95% CI 0.15-0.50, p < .01), but no difference in risk was seen in patients with histological steatohepatitis (RD liver vs. non-liver mortality, −0.32, −0.75 -0.10, p = .14) (supplementary Figure S5). Studies were compared in terms of the source of their data: single centre, multicentre or registry.…”

Natural history of histologically proven alcohol-related liver disease: A systematic review

“…Three sub-types of mortality were considered: overall mortality, non-liver related mortality and liver-specific mortality. Twenty-three studies described mortality outcomes (7,9,15,17,18,22,25,33,35,(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). In the eight studies (including 1091 participants) that reported mortality in alcohol related steatosis (7,9,18,25,43,45,46,49), overall annual mortality was 6.0% (95%CI 4.0 -7.0%), annual non-liver mortality was 4.0% (95%CI 3.0 -6.0%) and…”