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Christopher Berlin // März 2015
A Histologic Scoring System for Prognosis of Patients with Alcoholic Hepatitis
Altamirano et.al., Gastroenterology 2014
Christopher Berlin // März 2015
Subjects and Methods
Study Cohort
121 patientsmonocentric // Barcelonaone pathologist
retrospective
Validation Cohort
205 patientsmulticentric // international hospitalslocal pathologists, interobserver agreement
prospective
Inclusion criteria for study of short-term survival (90days)
alcohol consumption > 60g/day AST > ALTGGT ++Bilirubin ++Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis
Christopher Berlin // März 2015
Subjects and Methods
Study Cohort
121 patientsmonocentric // Barcelonaone pathologist
retrospective
Validation Cohort
205 patientsmulticentric // international hospitalslocal pathologists, interobserver agreement
prospective
Inclusion criteria for study of short-term survival (90days)
alcohol consumption > 60g/day AST > ALTGGT ++Bilirubin ++Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis
Christopher Berlin // März 2015
Subjects and Methods
Study Cohort
121 patientsmonocentric // Barcelonaone pathologist
retrospective
Validation Cohort
205 patientsmulticentric // international hospitalslocal pathologists, interobserver agreement
prospective
Inclusion criteria for study of short-term survival (90days)
alcohol consumption > 60g/day AST > ALTGGT ++Bilirubin ++Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis
Christopher Berlin // März 2015
Histologic Factors
Bilirubinostasis Fibrosis
+ PMN infiltration ++Megamitochondria
Christopher Berlin // März 2015
OR 2.67 OR 10.98 OR 1.9
OR 0.26 OR 1.0 OR 0.33
Histologic Factors // OR
Bilirubinostasis Fibrosis
+ PMN infiltration ++Megamitochondria
Christopher Berlin // März 2015
Prognostic Stratification of AH
Christopher Berlin // März 2015
Cutoff for different categories
AHHS points risk of death
Mild 0-3 low (3%)Moderate 4-5 intermediate (19%)Severe 6-9 high (51%)
Christopher Berlin // März 2015
Validation of histologic AHHS
Study Cohort Validation Cohort
Christopher Berlin // März 2015
Prognostic assessment of AHHS
ABIC class B MELD < 21
Christopher Berlin // März 2015
Associations with infections
Christopher Berlin // März 2015
Discussion
Novel histologic scoring system
-prediction of short-term survival -stratifying patients for clinical trials -identification of key disease drivers
- Fibrosis // portal hypertension- Bilirubinostasis // bacterial infections- PMN infiltration // early stages / stimulation of liver regeneration- Megamitochondria // early stages / protection of hepatocytes ?
-clinical decision making // inflammation ++ -refine of MELD < 21
- precise prognostic assessment by sequential use of ABIC/MELD and AHHS
Christopher Berlin // März 2015
Thank you for your attention
Christopher Berlin // März 2015
Prognostic assessment of AHHS
