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AHHS used to determine 90-day mortality rate among alcoholic hepatitis patients

Alcoholic hepatitis patients had the greatest risk for mortality within 90 days when they had a high alcoholic hepatitis histologic score, compared with patients with a low or moderate score, according to data from a recent study.

Researchers analyzed 121 patients with alcoholic hepatitis (AH) admitted to the Liver Unit in Barcelona, Spain between January 2000 and January 2008. A scoring system was developed and used in an updated test set of 96 patients from five additional centers in America and Europe. The alcoholic hepatitis histologic score (AHHS) was developed based on four parameters; degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis and presence of megamitochondria.

According to the results, the overall 90-day mortality rate was 29%. The risk of death within 90 days was based on scores of 0-3 (low), 4-5 (moderate) or 6-9 (high). Three percent of patients had a low score, 19% moderate and 51% high (P<.0001). The main causes of death were sepsis (29%) and multi-organ failure (52%).

In multivariate analysis, the presence of polymorphonuclear infiltration and megamitochondria were independently associated (OR=0.13; 95% CI, 0.03-0.47), (OR=0.12; 95% CI, -0.04 to -0.36). The estimated 90-day mortality rate, as determined by the AHHS, among the training and test sets resulted in a characteristic value of OR=0.77; 95% CI, 0.71-0.83. Patients with severe AHHS had increased risk of life-threatening complications during hospitalization compared with moderate and mild AHHS (P=.005).

“Our study reveals which main histologic features affect a patient’s outcome,” researchers said. “Some of the findings of our study will guide future research to develop new therapies for this “orphan” disease, which urgently needs new approaches…attempts to improve liver regeneration, rather than blocking inflammation, seem more appropriate for this patient population.”

Disclosure: The researchers report no relevant financial disclosures.