The Severity of Histological Lesions Is Predictive of Outcome in 138 Patients with Alcoholic Steatohepatitis
L Spahr, E Giostra, A Hadengue, L Rubbia-Brandt. University Hospitals of Geneva, Geneva, Switzerland
Background: Diagnosis of alcoholic steatohepatitis (ASH) is based on histology (ballooning/Mallory bodies; steatosis; neutrophils). Additional features include bile pigment, iron deposits, and ductular reaction. Whether the intensity of histological damage is of clinical significance is ill-defined. We studied the prognostic value of individual features on liver biopsy, as well as other parameters (age, MELD and Maddrey) to predict the 90-day mortality in patients with ASH.
Design: 138 patients and biopsy-proven ASH admitted over a 3-year period were studied. Clinical scores were calculated at time of biopsy. A semi-quantitative evaluation was performed, while blinded to patients' outcome: macrovesicular steatosis (>50%: +1); microvesicular steatosis (present: +1); hepatocellular damage (numerous Mallory: +1; frequent ballooning: +1); neutrophilic infiltration (severe: +1); iron deposits (moderate/severe: +1); ductular reaction (marked: +1); and bile pigments (moderate/severe: +1). All patients had cirrhosis. The 3-month survival status was recorded.
Results: Survival was 74%. Thirty seven patients died (median time 26 days). At univariate analysis, age > 50 yrs, Maddrey > 32, MELD > 19, bile pigments (all p<0.001), marked iron deposits (p<0.015), were associated with death. Bilirubin showed a weak but significant correlation with bile pigments (Kendall tau = 0.49, p<0.0001). On multivariate analysis (OR [95% CI]), an age > 50 yrs (3.8 [1.35-10.9]; a Maddrey > 32 (5.7 [1.7-19.7]; and bile pigments on biopsy (2.5 [1.2-5.2] were independent predictors of death.
Conclusions: Apart from description of features for the diagnosis of ASH, histology identifies bile pigments with a prognostic significance, together with an age > 50 yrs and a Maddrey's score > 32.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 156, Tuesday Morning