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Prognostic Value of the Alcoholic Hepatitis Histologic Score in Korean Patients with Biopsy-Proven Alcoholic Hepatitis

Gut and Liver 2020년 14권 5호 p.636 ~ 643
이동현, 최윤이, 배정모, 장미수, 주세경, 정용진, 이국래, 김병관, 김원,
소속 상세정보
이동현 ( Lee Dong-Hyeon ) - Seoul Metropolitan Government Seoul National University Boramae Medical Center Department of Internal Medicine
최윤이 ( Choi Youn-I ) - Seoul Metropolitan Government Seoul National University Boramae Medical Center Department of Internal Medicine
배정모 ( Bae Jeong-Mo ) - Seoul National University College of Medicine Seoul National University Hospital Department of Pathology
장미수 ( Chang Mee-Soo ) - Seoul National University College of Medicine SMG-SNU Boramae Medical Center Department of Pathology
주세경 ( Joo Sae-Kyung ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Internal Medicine
정용진 ( Jung Yong-Jin ) - SMG-SNU Boramae Medical Center Department of Internal Medicine
이국래 ( Lee Kook-Lae ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Internal Medicine
김병관 ( Kim Byeong-Gwan ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Internal Medicine
김원 ( Kim Won ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Internal Medicine

Abstract


Background/Aims: The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort.

Methods: We conducted a prospective cohort study of hospitalized Korean patients with AH between January 2010 and August 2017. Histopathological findings were assessed to determine the AHHS in all study subjects. Histopathological risk factors were examined by Cox regression analysis to predict overall survival (OS). Kaplan-Meier curves were plotted to assess the diagnostic performance of the AHHS.

Results: We recruited a total of 107 patients with biopsy-proven AH. None of the individual AHHS components were associated with 3-month mortality. However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months (all p<0.05, except fibrosis severity for 6-month mortality) and OS (all p<0.05). The modified AHHS classification as a binary variable (<5 vs ≥5) was also associated with OS (hazard ratio, 2.88; 95% confidence interval [CI], 1.50 to 5.56; p=0.002), and had higher predictive performance for OS (concordance index [C-index], 0.634; 95% CI, 0.561 to 0.707) than the original AHHS classification (mild vs moderate vs severe: C-index, 0.577; 95% CI, 0.498 to 0.656). This difference was statistically significant (p=0.045).

Conclusions: In this prospective Korean AH cohort, the modified AHHS was significantly associated with OS. Therefore, the AHHS might be a useful histological prognosticator for long-term prognosis in patients with nonsevere AH.

키워드

Hepatitis, alcoholic; Alcohol-related disorder; Classification; Biopsy; Prognosis

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