title: Alcoholic hepatitis histological score has high accuracy to predict 90-day mortality and response to steroids.
abstract: OBJECTIVE
  A histological classification system (AHHS) has been recently proposed to predict 90-day mortality in patients with alcoholic hepatitis (AH). We analyzed the spectrum of histological features in patients with AH and assessed the ability of AHHS for predicting both response to steroids and 90-day mortality.
  
  
  METHODS
  Retrospective study of patients admitted to our tertiary centre between 2010 and 2014 with biopsy-proven AH. Histological features were analyzed and AHHS value was calculated. Kaplan-Meyer curves were calculated to assess the ability of AHHS to predict response to steroids and 90-day mortality.
  
  
  RESULTS
  We included 34 patients (70.6% men, mean age 48.5±8.9 years). Transjugular liver biopsy was performed 3.5±2.9 days after admission. Presence of bilirubinostasis (p=0.049), degree of bilirubinostasis (p<0.001), absence of megamitochondria (p<0.001) and degree of polymorphonuclear infiltration (p=0.018) were significantly associated with higher mortality at 90 days. Patients who responded to steroids had a significantly lower AHHS value than non-responders (5.4±0.9 vs 8.1±1.1, p=0.003). AAHS value was significantly higher in patients who died compared to patients who survived at 90 days (9.0±0.7 vs 5.0±0.9, p<0.001). AHHS predicted response to steroids [AUROC 0.90 (CI95% 0.742-1.000), p=0.004] and 90-day mortality [AUROC 1.0 (CI95% 1.0-1.0), p<0.001] with high accuracy.
  
  
  CONCLUSIONS
  In this cohort of patients, presence and degree of bilirubinostasis, absence of megamitochondria and degree of PMN infiltration were significantly associated with 90-day mortality. AHHS had a high accuracy for predicting response to steroids and 90-day mortality in this cohort of patients.
authors.affiliation: Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal. Electronic address: anapatriciarandrade@gmail.com.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Andrade
authors.affiliation: Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Silva
authors.affiliation: Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: Pathology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lopes
authors.affiliation: Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Lopes
authors.affiliation: Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
mesh_terms: D000328:Adult; D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use*; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D013256:Steroids
keywords: 90-Day mortality; Alcoholic hepatitis; Histological findings; Response to steroids