A histologic scoring system for prognosis of patients with alcoholic hepatitis.
A histologic scoring system for prognosis of patients with alcoholic hepatitis.
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DOI：
10.1053/j.gastro.2014.01.018
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发表时间：
2014-05
期刊：
影响因子：
29.4
通讯作者：
Bataller R
中科院分区：
文献类型：
--
作者：
Altamirano J;Miquel R;Katoonizadeh A;Abraldes JG;Duarte-Rojo A;Louvet A;Augustin S;Mookerjee RP;Michelena J;Smyrk TC;Buob D;Leteurtre E;Rincón D;Ruiz P;García-Pagán JC;Guerrero-Marquez C;Jones PD;Barritt AS 4th;Arroyo V;Bruguera M;Bañares R;Ginès P;Caballería J;Roskams T;Nevens F;Jalan R;Mathurin P;Shah VH;Bataller R
酒精性肝炎(AH)患者的预后尚无组织学分类系统。我们确定了与疾病严重程度相关的组织学特征，并创建了一个组织学评分系统来预测短期(90天)死亡率。我们分析了2000年1月至2008年1月在西班牙巴塞罗那医院诊所肝科住院的121名具有AH特征的患者的数据，并开发了一种组织学评分系统，以使用Logistic回归来确定死亡风险。该系统在来自美国和欧洲5个学术中心的96名患者的测试集中进行了测试和更新，并开发了一个半定量评分系统，称为酒精性肝炎组织学评分(AHS)。该系统在一组独立的109名患者中得到了验证。观察者间的一致性通过加权统计分析进行评估。纤维化程度、中性粒细胞渗透、胆红素淤积类型和存在巨型线粒体与90天死亡率独立相关。我们使用这4个参数来开发AHHS，以确定90天内死亡风险低(0-3分)、中等(4-5分)和高(6-9分)的患者(分别为3%、19%和51%；P<；.0001)。AHHS估计训练和测试集中90天的死亡率，接收器操作特征值下的面积为0.77(95%可信区间，0.71-0.83)。肝纤维化、胆红素淤滞、中性粒细胞浸润和巨细胞线粒体的符合率分别为0.65、0.86、0.60和0.46。有趣的是，胆红素淤积的类型预测了细菌感染的发展。我们确定了与急性脑出血严重程度相关的组织学特征，并开发了一个可能用于临床决策的患者分类系统。
There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90 day) mortality. We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 through January 2008 with features of AH, and developed a histologic scoring system to determine risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the US and Europe, and a semi-quantitative scoring system was developed, called the alcoholic hepatitis histologic score (AHHS). The system was validated in an independent set of 109 patients. Inter-observer agreement was evaluated by weighted statistic analysis. Degree of fibrosis, neutrophil infiltration, type of bilirubinostasis, and presence mega-mitochondria were independently associated with 90 day mortality. We used these 4 parameters to develop the AHHS to identify patients with low (0–3 points), moderate (4–5 points), and high (6–9 points) risks of death within 90 days (3%, 19%, and 51%, respectively; P<.0001). The AHHS estimated 90 day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71–0.83). Inter-rate agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections. We identified histologic features associated with severity of AH and developed a patient classification system that might be used in clinical decision making.
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