title: Presence of alcoholic steatohepatitis, but no selective histological feature, indicates an increased risk of cirrhosis and premature death.
abstract: OBJECTIVE
  The prognostic impact of early stages of histologically confirmed alcoholic liver disease is uncertain. Our aim was to determine the risk of cirrhosis and premature death, and identify prognostic markers, in patients with biopsy-proven alcoholic steatohepatitis - and to compare prognosis in patients with alcoholic pure fatty liver and the general population.
  
  
  METHODS
  Patients with biopsy-proven alcoholic fatty liver disease diagnosed during 1976-1987 were identified. Data were collected from medical records, the Danish National Patient Registry and the Registry of Causes of Death. All biopsies were re-examined and morphological findings assessed. A reference cohort matched for age and gender was created. Cox proportional hazard models adjusted for age and gender were used to analyse differences in mortality and cirrhosis development, as well as the prognostic impact of histological and biochemical parameters.
  
  
  RESULTS
  Two hundred and twenty-five patients with fatty liver and 111 with steatohepatitis were followed for median 13 and 9.7 years, respectively. There was a significantly higher risk of developing cirrhosis amongst patients with steatohepatitis compared to both patients with fatty liver (p < 0.001) and the reference cohort (p < 0.001). Mortality was significantly higher in patients with steatohepatitis compared to patients with fatty liver (p = 0.046) and the general population (p < 0.001). No histological or biochemical parameters with prognostic significance for mortality were identified.
  
  
  CONCLUSIONS
  Presence of steatohepatitis indicates an increased risk of cirrhosis and premature death. However, none of the histological parameters defining steatohepatitis can independently identify patients at risk for premature death.
authors.affiliation: a Gastro Unit , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Synne
authors.initials: S
authors.lastname: Semb
authors.affiliation: a Gastro Unit , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;|b National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ;
authors.forename: Søren
authors.initials: S
authors.lastname: Neermark
authors.affiliation: c Department of Medicine , Zealand University Hospital , Køge , Denmark ;
authors.forename: Sanne
authors.initials: S
authors.lastname: Dam-Larsen
authors.affiliation: d Department of Pathology , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Maria Benedicte
authors.initials: MB
authors.lastname: Franzmann
authors.affiliation: d Department of Pathology , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Jens
authors.initials: J
authors.lastname: Albrectsen
authors.affiliation: e Clinical Research Center , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;|f Department of Orthopedic Surgery , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kallemose
authors.affiliation: a Gastro Unit , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;|b National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ;
authors.forename: Ulrik
authors.initials: U
authors.lastname: Becker
authors.affiliation: a Gastro Unit , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002423:Cause of Death; D003718:Denmark; D018450:Disease Progression; D005235:Fatty Liver, Alcoholic / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Alcoholic fatty liver; alcoholic liver disease; alcoholic steatohepatitis; cirrhosis; prognosis