title: Low-grade steatosis and major changes in portal flow as new prognostic factors in steroid-treated alcoholic hepatitis.
abstract: 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.
authors.affiliation: Service d'Hépatologie et de Gastroentérologie, Unité de Transplantation Hépatique and INSERM U581, Créteil, France. cduvoux@easynet.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.forename: Catherine
authors.initials: C
authors.lastname: Radier
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: François
authors.initials: F
authors.lastname: Maille
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Anglade
authors.forename: Jeanne Tran
authors.initials: JT
authors.lastname: Van Nhieu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rosa
authors.forename: Sylvie
authors.initials: S
authors.lastname: Hospitel
authors.forename: Issam
authors.initials: I
authors.lastname: Abd-Alsamad
authors.forename: Véronique
authors.initials: V
authors.lastname: Sitruk
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
authors.forename: Marianne
authors.initials: M
authors.lastname: Ziol
authors.forename: Hughes
authors.initials: H
authors.lastname: Blondon
authors.forename: Daniel
authors.initials: D
authors.lastname: Dhumeaux
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Richardet
mesh_terms: 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
chemical_list: D013256:Steroids