Transjugular liver biopsy in severe alcoholic hepatitis

Shetty, Shiran; Venkatakrishnan, L; Krishanveni, J; Kumari, Shantha

doi:10.1007/s12664-016-0720-6

Cited by 6 publications

(12 citation statements)

References 14 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

“… 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). Criteria used to define AH on histology were also heterogeneous.…”

Section: Resultsmentioning

confidence: 99%

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

Verma,

Mehtani,

Haiar

et al. 2024

Hepatology Communications

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Background: The precision of clinical criteria and the utility of liver biopsy for diagnosis or prognosis remain unclear in patients with alcohol-associated hepatitis (AH). We systematically reviewed the literature to answer these questions. Methods: Four databases were searched for studies describing the precision of clinical criteria (National Institute on Alcohol Abuse and Alcoholism, European Association for Study of Liver, or classical) and the role of histology in AH. The precision(positive predictive value) of criteria was pooled through random-effects meta-analysis, and its variation was investigated through subgroups and meta-regression of study-level factors with their percent contribution to variation (R 2). The risk of bias among studies was evaluated through the QUADAS2 tool (PROSPERO-ID-CRD4203457250). Results: Of 4320 studies, 18 in the systematic review and 15 (10/5: low/high risk of bias, N=1639) were included in the meta-analysis. The pooled precision of clinical criteria was 80.2% (95% CI: 69.7–89.7, I 2:93%, p < 0.01), higher in studies with severe AH (mean-Model for End-Stage Liver Disease > 20) versus moderate AH (mean-Model for End-Stage Liver Disease < 20): 92% versus 67.1%, p < 0.01, and in studies with serum bilirubin cutoff 5 versus 3 mg/dL (88.5% vs.78.8%, p = 0.01). The factors contributing to variation in precision were Model for End-Stage Liver Disease (R 2:72.7%), upper gastrointestinal bleed (R 2:56.3%), aspartate aminotransferase:aspartate aminotransferase ratio (R 2:100%), clinical criteria (R 2:40.9%), bilirubin (R 2:22.5%), and Mallory body on histology (R 2:19.1%). The net inter-pathologist agreement for histologic findings of AH was variable (0.33–0.97), best among 2 studies describing AH through simple and uniform criteria, including steatosis, ballooning, and neutrophilic inflammation. Few studies reported the utility of histology in estimating steroid responsiveness (N = 1) and patient prognosis (N = 4); however, very broad septa, pericellular fibrosis, and cholestasis were associated with mortality. Bilirubinostasis was associated with infection in 1 study. Conclusions: Clinical criteria are reasonably precise for diagnosing severe AH, while there is an unmet need for better criteria for diagnosing moderate AH. Histologic diagnosis of AH should be simple and uniform.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Verma,

Mehtani,

Haiar

et al. 2024

Hepatology Communications

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“…It is reported that the majority of AH patients have underlying cirrhosis, although the prevalence rates have varied from 30-100% in different series. 5,6,52…”

Section: Liver Biopsy: Technique and Findingsmentioning

confidence: 99%

“…The literature is conflicting regarding the role of liver biopsy for diagnosis of AH 37,40,43,[52][53][54][55] .…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Liver Biopsy in Patients With Alcohol-Associated Liver Disease With Acute-on-Chronic Liver Failure

Jophlin

Singal

2022

Journal of Clinical and Experimental Hepatology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Alcoholic and Non-Alcoholic Fatty Liver Diseases

Kanel

2024

Atlas of Liver Pathology

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Transjugular liver biopsy in severe alcoholic hepatitis

Abstract: Cirrhosis is found in one third of patients with severe alcoholic hepatitis. This may alter our approach to management of this condition.

Cited by 6 publications

References 14 publications

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

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

Liver Biopsy in Patients With Alcohol-Associated Liver Disease With Acute-on-Chronic Liver Failure

Alcoholic and Non-Alcoholic Fatty Liver Diseases

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