Low-grade steatosis and major changes in portal flow as new prognostic factors in steroid-treated alcoholic hepatitis.
The aim of this study was to assess the prevalence and prognostic value of major alterations of portal flow in patients with steroid-treated alcoholic hepatitis. Fifty patients with severe, histologically proven alcoholic hepatitis were enrolled. Clinical data, liver test results, and hepatic Doppler ultrasound findings were collected at inclusion and at month 2. Patients were followed for 1 year or until death. Major changes in portal flow were defined as reversed or alternating flow in the portal trunk and/or in intrahepatic portal branches. Changes in portal flow were observed in 24 (48.0%) of 50 and 17 (39.5%) of 43 patients at inclusion and month 2, respectively. Univariate analysis showed that age older than 50 years, steatosis less than 20% on initial liver biopsy, presence of major changes in portal flow, Child-Turcotte-Pugh score higher than 12, factor V level higher than 45%, and hepatofugal splenic blood flow were associated with a lower 1-year survival. Cox regression analysis showed that steatosis < 20% (relative hazard [RH] = 9.3, P = .0009) and major changes in portal flow (RH = 3.1, P = .04), were independently associated with poor survival. In conclusion, major changes in portal flow are frequent in patients with severe alcoholic hepatitis. Altered portal flow and steatosis < 20% are new prognostic factors in steroid-treated alcoholic hepatitis and must be taken into account in patient management.
Duvoux
Christophe
C
Service d'Hépatologie et de Gastroentérologie, Unité de Transplantation Hépatique and INSERM U581, Créteil, France. cduvoux@easynet.fr
Radier
Catherine
C
Roudot-Thoraval
Françoise
F
Maille
François
F
Anglade
Marie-Christine
MC
Van Nhieu
Jeanne Tran
JT
Rosa
Isabelle
I
Hospitel
Sylvie
S
Abd-Alsamad
Issam
I
Sitruk
Véronique
V
Seror
Olivier
O
Ziol
Marianne
M
Blondon
Hughes
H
Dhumeaux
Daniel
D
Richardet
Jean-Philippe
JP
D000328:Adult; D001706:Biopsy; D005234:Fatty Liver / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000502:physiology; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011168:Portal System / Q000502:physiology*; D015995:Prevalence; D011379:Prognosis; D013256:Steroids / Q000627:therapeutic use*; D015996:Survival Rate
D013256:Steroids