Collagen proportionate area predicts long-term mortality in patients with alcoholic hepatitis.

Mads Israelsen,Andrew Hall,Laura Iogna Prat,Davide Roccarina,Emmanuel A Tsochatzis,Massimo Pinzani,Alberto Quaglia,Marta Guerrero Misas,Elena Buzzetti,Tu Vinh Luong,Claudia Covelli,Anastasios Koutsoumourakis

doi:10.1016/j.dld.2021.08.021

Abstract

There are several short-term prognostic scores for alcoholic hepatitis (AH) that combine demographical and biochemical parameters. The extent of liver fibrosis may also be relevant to the prognosis of AH with potential added value. We evaluated collagen proportionate area (CPA) as a predictor of short and long-term mortality in AH. We retrospectively included patients with biopsy-verified AH. Clinical, laboratory and outcome data were collected. CPA and five AH scores were calculated: Maddrey's DF, MELD, GAHS, ABIC, and the Lille Model. Predictors of short and long-term all-cause mortality were assessed using Cox regression analysis. We included 140 patients with AH. In total, 67 (48%) patients died after a median follow-up of 66 (IQR 102) months, with 17 (12%) dying within the first 90-days. CPA was not a predictor of 90-days mortality and had no additional value to the prognostic AH scores on short-term mortality. However, CPA predicted long-term mortality independently of prognostic AH scores. Importantly, CPA and abstinence from alcohol were independent predictors of long-term mortality in patients alive 90 days after the biopsy. CPA predicts long-term mortality in patients with AH independently of abstinence from alcohol but has no prognostic value on short-term mortality.

Highlights

Alcoholic hepatitis (AH) has 30-days mortality of up to 30% [1] and five-year mortality of around 50% [2]
We found that collagen proportionate area (CPA) did not predict mortality during the acute event, it was associated with higher risk of death in patients who recovered from alcoholic hepatitis
A biopsy-controlled study demonstrated that the presence of advanced fibrosis or cirrhosis was a strong predictor of 90-days mortality independent of other prognostic scores [10], and prevalence of cirrhosis has been associated with increased short-term and long-term mortality in patients with AH in population-based studies [2]

Summary

Introduction

Alcoholic hepatitis (AH) has 30-days mortality of up to 30% [1] and five-year mortality of around 50% [2]. A biopsy-controlled study demonstrated that the presence of advanced fibrosis or cirrhosis was a strong predictor of 90-days mortality independent of other prognostic scores [10], and prevalence of cirrhosis has been associated with increased short-term and long-term mortality in patients with AH in population-based studies [2]. This indicates that the extent of liver fibrosis predicts the outcome of AH and may have added value to the established prognostic AH scores for short-term mortality. Conclusion: CPA predicts long-term mortality in patients with AH independently of abstinence from alcohol but has no prognostic value on short-term mortality

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