Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (29)
- Mathurin P, "Trends in the management and burden of alcoholic liver disease", J Hepatol, 62(1 Suppl), pp.S38~S46 (2015)
- Lee JY, "Incidence, inhospital mortality, and readmission among patients with alcoholic hepatitis in Korea : a nationwide study", J Gastroenterol Hepatol, 34, pp.747~754 (2019)
- Lucey MR, "Alcoholic hepatitis", N Engl J Med, 360, pp.2758~2769 (2009)
- Crabb DW, "Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis : recommendation from the NIAAA Alcoholic Hepatitis Consortia", Gastroenterology, 150, pp.785~790 (2016)
- European Association for the Study of the Liver, "EASL clinical practice guidelines : management of alcohol-related liver disease", J Hepatol, 69, pp.154~181 (2018)
- Maddrey WC, "Corticosteroid therapy of alcoholic hepatitis", Gastroenterology, 75, pp.193~199 (1978)
- Kamath PS, "A model to predict survival in patients with end-stage liver disease", Hepatology, 33, pp.464~470 (2001)
- Dominguez M, "A new scoring system for prognostic stratification of patients with alcoholic hepatitis", Am J Gastroenterol, 103, pp.2747~2756 (2008)
- Forrest EH, "Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score", Gut, 54, pp.1174~1179 (2005)
- Lee M, "Spontaneous evolution in bilirubin levels predicts liver-related mortality in patients with alcoholic hepatitis", PLoS One, 9, pp.e100870~ (2014)
- Louvet A, "The Lille model : a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids", Hepatology, 45, pp.1348~1354 (2007)
- Mathurin P, "Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone", Gastroenterology, 110, pp.1847~1853 (1996)
- Chedid A, "Significance of megamitochondria in alcoholic liver disease", Gastroenterology, 90, pp.1858~1864 (1986)
- Katoonizadeh A, "Early features of acute-on-chronic alcoholic liver failure : a prospective cohort study", Gut, 59, pp.1561~1569 (2010)
- Spahr L, "Early liver biopsy, intraparenchymal cholestasis, and prognosis in patients with alcoholic steatohepatitis", BMC Gastroenterol, 11, pp.115~ (2011)
- Mookerjee RP, "The role of liver biopsy in the diagnosis and prognosis of patients with acute deterioration of alcoholic cirrhosis", J Hepatol, 55, pp.1103~1111 (2011)
- Altamirano J, "A histologic scoring system for prognosis of patients with alcoholic hepatitis", Gastroenterology, 146, pp.1231~1239 (2014)
- Garcia-Tsao G, "Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis", Hepatology, 46, pp.922~938 (2007)
- Moore KP, "The management of ascites in cirrhosis : report on the consensus conference of the International Ascites Club", Hepatology, 38, pp.258~266 (2003)
- Runyon BA, "Management of adult patients with ascites due to cirrhosis", Hepatology, 39, pp.841~856 (2004)
- Ferenci P, "Hepatic encephalopathy : definition, nomenclature, diagnosis, and quantification : final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998", Hepatology, 35, pp.716~721 (2002)
- Colmenero J, "Hepatic expression of candidate genes in patients with alcoholic hepatitis : correlation with disease severity", Gastroenterology, 132, pp.687~697 (2007)
- Kang L, "Comparing two correlated C indices with right-censored survival outcome : a one-shot nonparametric approach", Stat Med, 34, pp.685~703 (2015)
- Andrade P, "Alcoholic hepatitis histological score has high accuracy to predict 90-day mortality and response to steroids", Dig Liver Dis, 48, pp.656~660 (2016)
- Rincon D, "Prognostic value of hepatic venous pressure gradient for in-hospital mortality of patients with severe acute alcoholic hepatitis", Aliment Pharmacol Ther, 25, pp.841~848 (2007)
- Dunn W, "MELD accurately predicts mortality in patients with alcoholic hepatitis", Hepatology, 41, pp.353~358 (2005)
- Lu XL, "Risk factors for alcoholic liver disease in China", World J Gastroenterol, 10, pp.2423~2426 (2004)
- Eng MY, "ALDH2, ADH1B, and ADH1C genotypes in Asians : a literature review", Alcohol Res Health, 30, pp.22~27 (2007)
- Horvath B, "Interobserver variability in scoring liver biopsies with a diagnosis of alcoholic hepatitis", Alcohol Clin Exp Res, 41, pp.1568~1573 (2017)