Scoring system predicts mortality in alcoholic hepatitis

A novel scoring system, dubbed the alcoholic hepatitis histologic score, may aid in predicting 90-day survival in patients presenting with alcoholic hepatitis, according to researchers.

Currently, there is no system built to determine the outcomes of alcoholic hepatitis. For this reason, researchers created a histologic scoring system to predict 90-day mortality among 121 patients with features of alcoholic hepatitis treated at the Liver Unit at the Hospital Clinic in Barcelona between 2000 and 2008.

The system was tested and updated in 96 patients across five academic centers in the United States and Europe and assessed in a validation cohort of 109 patients.

Factors independently associated with 90-day mortality included:

• Degree of fibrosis
• Neutrophil infiltration
• Type of bilirubinostasis
• Presence of mega-mitochondria

These four factors were used in determining patients at low (0-3 points; 3%), moderate (4–5 points; 19%) or high (6–9 points; 51%) risk for death within 90 days (P<0.0001).

The area under the receiver operating characteristic value was 0.77 (95% CI, 0.71-0.83). Additionally, inter-rate agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration and 0.46 for megamitochondria.

The type of bilirubinostasis predicted the development of bacterial infections, the researchers found.

“A striking finding of our study is that the presence and type of bilirubinostasis has a marked influence in short-term mortality,” the researchers wrote. “In fact, alcoholic hepatitis is analytically characterized by profound cholestasis and serum bilirubin levels are one of the most powerful predictors for poor outcome in these patients. Our results confirm previous studies suggesting that bilirubinostasis is one of the most ominous findings in patients with alcoholic hepatitis.”