Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis

Abstract

Background/Aims The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. Methods We conducted a prospective cohort study of hospitalized Korean patients with AH between January 2010 and August 2017. Histopathological findings were assessed to determine the AHHS in all study subjects. Histopathological risk factors were examined by Cox regression analysis to predict overall survival (OS). Kaplan-Meier curves were plotted to assess the diagnostic performance of the AHHS. Results We recruited a total of 107 patients with biopsy-proven AH. None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months (all p<0.05, except fibrosis severity for 6-month mortality) and OS (all p<0.05). The modified AHHS classification as a binary variable (<5 vs ≥5) was also associated with OS (hazard ratio, 2.88; 95% confidence interval [CI], 1.50 to 5.56; p=0.002), and had higher predictive performance for OS (concordance index [C-index], 0.634; 95% CI, 0.561 to 0.707) than the original AHHS classification (mild vs moderate vs severe C-index, 0.577; 95% CI, 0.498 to 0.656). This difference was statistically significant (p=0.045). Conclusions In this prospective Korean AH cohort, the modified AHHS was significantly associated with OS. Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH.

Clinical criteria accurately diagnose severe but not moderate alcohol-associated hepatitis: A systematic review and meta-analysis

“…Thirty-one articles were excluded due to various reasons (Figure 1 ). Finally, 18 studies 9 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 were included in the systematic review. Three studies 26 27 28 did not provide data on the precision of clinical criteria for AH, leaving 15 studies for the quantitative meta-analysis.…”

“…Of 18 studies, 9 were retrospective, 14 16 17 20 23 24 26 27 28 and 9 were prospective studies. 9 12 13 15 18 19 21 22 25 Of 15 studies included in the meta-analysis, 4 studies used NIAAA criteria, 17 20 22 25 4 used Classical criteria, 16 19 23 24 6 used European Association for Study of Liver 2012 criteria, 9 12 13 14 15 18 while 1 study did not report as to which criteria were used. 21 Eight studies 13 14 15 16 17 22 23 24 included patients with severe AH as defined by a discriminant function (DF ≥ 32).…”

Liver surface nodularity and ascites are associated with mortality risk in acute alcohol‐associated hepatitis

“…Finally, the addition of a composite score for ascites and LSN >2.86 a.u. (AHRADS score) to MELD improved the model performance for outcome prediction when compared to MELD alone.In a large multicenter analysis of 326 patients with biopsyproven AH, we previously demonstrated that advanced fibrosis or cirrhosis on liver histology was associated with an 11-fold increase in 90-day mortality in both univariate and multivariate models(Altamirano et al, 2014), and this observation has been reproduced in multiple studies(Andrade et al, 2016;Lee et al, 2020). Additionally, more advanced fibrosis has been linked to increased severity of portal hypertension and hepatic decompensation in AH (Mookerjee…”

Current and future treatment for alcoholic‐related liver diseases

“…Notwithstanding the decreased role of liver biopsy in clinical trials, the alcoholic hepatitis histologic scores consisting of polymorphonuclear cell infiltration, megamitochondria, bilirubinostasis, and fibrosis stage aid in the prognostic stratification of patients with alcoholic hepatitis. 11,12 Severity of alcoholic hepatitis is assessed with either Maddrey's discriminant function (DF) value of 32 and higher or a model for end-stage liver disease (MELD) score of 20 and higher. Traditionally, 28-day mortality rate is presumed to be as high as 20-50% in the case of severe alcoholic hepatitis.…”

“…), and (iii) possible alcoholic hepatitis presenting with confounding factors or atypical laboratory findings, requiring liver biopsy to confirm or rule out other liver diseases. Notwithstanding the decreased role of liver biopsy in clinical trials, the alcoholic hepatitis histologic scores consisting of polymorphonuclear cell infiltration, megamitochondria, bilirubinostasis, and fibrosis stage aid in the prognostic stratification of patients with alcoholic hepatitis 11,12 . Severity of alcoholic hepatitis is assessed with either Maddrey's discriminant function (DF) value of 32 and higher or a model for end‐stage liver disease (MELD) score of 20 and higher.…”