Christopher Berlin // März 2015 A Histologic Scoring System for Prognosis of Patients with Alcoholic Hepatitis Altamirano et.al., Gastroenterology 2014.

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Presentation transcript:

Christopher Berlin // März 2015 A Histologic Scoring System for Prognosis of Patients with Alcoholic Hepatitis Altamirano et.al., Gastroenterology 2014

Christopher Berlin // März 2015 Subjects and Methods Study Cohort 121 patients monocentric // Barcelona one pathologist retrospective Validation Cohort 205 patients multicentric // international hospitals local pathologists, interobserver agreement prospective Inclusion criteria for study of short-term survival (90days) alcohol consumption > 60g/day AST > ALT GGT ++ Bilirubin ++ Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis

Christopher Berlin // März 2015 Subjects and Methods Study Cohort 121 patients monocentric // Barcelona one pathologist retrospective Validation Cohort 205 patients multicentric // international hospitals local pathologists, interobserver agreement prospective Inclusion criteria for study of short-term survival (90days) alcohol consumption > 60g/day AST > ALT GGT ++ Bilirubin ++ Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis

Christopher Berlin // März 2015 Subjects and Methods Study Cohort 121 patients monocentric // Barcelona one pathologist retrospective Validation Cohort 205 patients multicentric // international hospitals local pathologists, interobserver agreement prospective Inclusion criteria for study of short-term survival (90days) alcohol consumption > 60g/day AST > ALT GGT ++ Bilirubin ++ Histology: hepatocellular damage, inflammatory infiltration, pericellular fibrosis

Christopher Berlin // März 2015 Histologic Factors BilirubinostasisFibrosis + PMN infiltration ++ Megamitochondria

Christopher Berlin // März 2015 OR 2.67 OR OR 1.9 OR 0.26 OR 1.0OR 0.33 Histologic Factors // OR BilirubinostasisFibrosis + PMN infiltration ++ Megamitochondria

Christopher Berlin // März 2015 Prognostic Stratification of AH

Christopher Berlin // März 2015 Cutoff for different categories AHHS pointsrisk of death Mild 0-3low (3%) Moderate 4-5intermediate (19%) Severe 6-9high(51%)

Christopher Berlin // März 2015 Validation of histologic AHHS Study Cohort Validation Cohort

Christopher Berlin // März 2015 Prognostic assessment of AHHS ABIC class B MELD < 21

Christopher Berlin // März 2015 Associations with infections

Christopher Berlin // März 2015 Discussion Novel histologic scoring system -prediction of short-term survival -stratifying patients for clinical trials -identification of key disease drivers -Fibrosis //portal hypertension -Bilirubinostasis //bacterial infections -PMN infiltration//early stages / stimulation of liver regeneration -Megamitochondria //early stages / protection of hepatocytes ? -clinical decision making //inflammation ++ -refine of MELD < 21 -precise prognostic assessment by sequential use of ABIC/MELD and AHHS

Christopher Berlin // März 2015 Thank you for your attention

Christopher Berlin // März 2015 Prognostic assessment of AHHS