Severity Of Alcoholic Hepatitis Research Articles

Drugging the Gut Microbiome for the Treatment of Alcohol‐Induced Liver Injury

ObjectivesSustained alcohol abuse initiates a progressive disease pathogenesis involving simple steatosis, steatohepatitis, fibrosis, cirrhosis, and in some cases hepatocellular carcinoma. There is mounting evidence that microbes resident in the human intestine represent a key transmissible factor promoting inflammatory diseases including alcoholic liver disease (ALD). However, mechanisms by which gut microbiota synergize with excessive alcohol intake to promote ALD are poorly understood. We have recently revealed a metaorganismal pathway where nutrients in high fat foods can be metabolized by gut microbes to generate trimethylamine (TMA), which is subsequently metabolized by the host enzyme flavin‐containing monooxygenase 3 (FMO3) to produce the pro‐atherogenic metabolite trimethylamine‐N‐oxide (TMAO). Hepatic FMO3 mRNA levels are suppressed in alcoholics and breath levels of TMA correlate with the severity of alcoholic hepatitis. Thus, this study investigates whether pharmacological inhibition of gut microbe‐derived TMA production can blunt ethanol‐induced liver injuryMethods and ResultsWe first determined if ethanol feeding would alter circulating TMA and TMAO levels in mice. Acute (6% vol/vol Lieber DiCarli) and chronic (25 days Lieber DiCarli) isocaloric pair‐ and ethanol‐feeding elicited increases in both TMA and TMAO levels. We then employed a novel approach to block TMA production by using a small molecule inhibitor (CC08) targeting the gut microbial TMA‐producing enzyme CutC/D. CC08 treatment effectively abolished ethanol‐elicited increases in TMA and TMAO. In parallel, CC08 treated mice were completely protected against ethanol‐induced hepatic fat deposition, hepatocellular inflammation, and elevated alanine aminotransferase levels. Collectively, these results suggest inhibiting gut microbial production of TMA can blunt ethanol‐induced liver injury.ConclusionsOur results establish the TMA/TMAO pathway as an important regulator of ethanol‐induced liver injury. Inhibition of TMA production by utilizing small molecule inhibitors targeting the TMA lyase, such as CC08, may represent a novel therapeutic approach to combat ethanol‐induced liver injury.Support or Funding InformationP50 (AA024333‐01)

Effects of Age, Sex, Body Weight, and Quantity of Alcohol Consumption on Occurrence and Severity of Alcoholic Hepatitis.

Only a minority of heavy drinking individuals develop alcoholic hepatitis (AH), for unclear reasons. We analyzed data from the Translational Research and Evolving Alcoholic Hepatitis Treatment cohort, consisting of subjects who drink heavily with normal results from liver tests (controls) and patients with AH. We examined risk factors for the development of AH including body mass index (BMI), drinking pattern and quantity, and sex. We compared data from 145 patients with AH and 124 controls based on BMI when they joined the cohort; groups were matched for sex and race. Drinking patterns were assessed using the timeline followback method, the Alcohol Use Disorders Identification Test, and the National Institute of Alcohol Abuse and Alcoholism 6-question survey. We performed univariable and multivariable analyses to assess the effects of these factors and their interaction in increasing the risk for AH. We also explored the association between PNPLA3 variants and AH. Cases with AH were older (47 vs 44 y; P= .03). For nearly all measures of quantity of alcohol consumed or frequency of binge drinking, controls drank more heavily than cases with AH. We did not find an association between BMI, sex, drinking patterns, and the presence of AH. Age and BMI were independent predictors for the severity of AH. When we analyzed cases and controls of European ancestry, the PNPLA3 single-nucleotide polymorphism rs738409 was associated with risk for AH (odds ratio, 1.89; P= .007). Compared with heavy drinkers without liver disease, subjects with AH consumed lower levels of alcohol and had less binge drinking, suggesting an increased sensitivity to the toxic effects of alcohol. The risk for AH may be associated with the PNPLA3 rs738409 polymorphism.

PS078 - Circulating Microparticles Correlate with Severity of Alcoholic Hepatitis, Predict Early Non-Response to Corticosteroid Therapy and Trigger Sterile Inflammation

PS078 - Circulating Microparticles Correlate with Severity of Alcoholic Hepatitis, Predict Early Non-Response to Corticosteroid Therapy and Trigger Sterile Inflammation

Effects of Age, Sex, Body Weight, and Quantity of Alcohol Consumption on Occurrence and Severity of Alcoholic Hepatitis

Effects of Age, Sex, Body Weight, and Quantity of Alcohol Consumption on Occurrence and Severity of Alcoholic Hepatitis

Is Serum Ferritin a Predictor of the Severity of Alcoholic Hepatitis

Background and Aims: Heavy alcohol consumption is associated with iron overload and elevated serum ferritin levels, and leads to liver injury and alcoholic liver disease. The severity of alcoholic hepatitis (AH) is measured using discriminant function (DF < 32 or DF > 32). But very few studies attempted to correlate the serum ferritin level and severity of AH. Hence, we tried to find out whether serum ferritin correlated with severity of AH and also tried to find a cut-off value to diagnose severe AH. Methods: All patients admitted with AH over an 18-month period (cross-sectional study) were divided into two groups depending on DF <32 (GROUP I) and DF >32 (GROUP II). Univariate and multivariate analyses were done using DF as the independent factor. The ability of serum ferritin to predict the severity of AH was evaluated using receiver–operating characteristics (ROC) curve to find area under curve (AUC) and to derive a cut-off level. Results: The study included 160 patients (100% males mean age 44.7 years) with 24 patients in Group I and 136 patients in Group II. Univariate analysis showed that age, CTP, CHILD, MELD, Bilirubin, PTINR, Albumin, Sodium, Ferritin and Infection were statistically significant. In multivariate analysis, age, CTP, ferritin, Albumin and infection came out as independent predictors. We plotted ROC curve taking serum ferritin level and DF and got AUC 0.917 {95% CI (0.87–0.966)} with P = 0.000. A ferritin cut-off level of 212.0 or above (sensitivity 82.6%; specificity 84.3%) clearly showed severe AH. However, we compared serum ferritin level with and without infection and found that even without infection ferritin levels are higher (697.0 vs 576.0; P = 0.115). Conclusion: Serum ferritin can be used as a marker to assess the severity of alcoholic hepatitis irrespective of infection.Table 1Multivariate Logistic Regression Analysis.VariablesUnstandardised coefficientsStandardised coefficientsTPBStd. ErrorBetaAge−.010.003−.189−3.345.001CTP.100.016.5506.079.000MELD.003.007.039.373.709Albumin.131‘.036.2333.631.000PTINR.018.040.035.444.657Ferritin.000.000.4085.526.000Infections−.209.042−.291−5.014.000 Open table in a new tab

Prognostic Indexes for Alcoholic Hepatitis

Alcohol abuse is the major source of liver disease. The prevalence of alcoholic hepatitis (AH) is unknown, but histologic studies demonstrated that AH may be present in approximately 10% to 35% of hospitalized patients with alcoholism. The assessment of severity permits the identification of patients that will improve without medical therapy and those that will have a high mortality if not treated. A variety of scoring systems has been used to quantity the severity of AH and guides its treatment. The scores more commonly used are: Maddrey’s discriminant function (DF), Model for End-Stage Liver Disease (MELD), Glasgow Alcoholic Hepatitis Score (GAHS) and Age, serum Bilirubin, INR (International Normalized Ratio), and serum Creatinine (ABIC). Some others prognostic indexes assess the efficacy of treatment, like Lille score, and Early Change in Bilirubin Levels. Histologic findings are showed to predict additional findings like risk of infection and poor prognosis even in a subgroup considered of better prognosis. The authors strongly recommend liver biopsy to confirm the diagnosis of AH and to discriminate patients with risk of infection and death without medical therapy. In our point of view, this method has been showed to be the best prognostic markers for AH in nowadays. In conclusion, AH is a severe complication among heavy drinkers and frequently results in poor short term prognosis. Various clinical scores are useful to differentiate patients with high mortality if not treated and are similar in predicting the outcome. More recently, the liver biopsy and a histologic score including fibrosis, megamitochondria, neutrophil infiltration and bilirubinostasis showed promising results and should be recommended.

Assessment of Severity of Alcoholic Hepatitis Episode: Comparison of Discriminant Function, MELD, and Glasgow Alcoholic Hepatitis Scores

Introduction: Alcoholic hepatitis (AH) is a distinct syndrome among patients with chronic and active alcohol abuse and has a potential for 30-40% mortality at 1 month among patients with severe disease. Various scores have been developed to assess the disease severity, however, none is an ideal score. We performed this study with an aim to compare discriminant function (DF), model for end-stage disease (MELD), and Glasgow alcoholic hepatitis score (GAHS) on their accuracy in assessing the severity of AH as determined by in-hospital and 30-day mortality. Methods: Medical charts were reviewed for patients admitted to 1 tertiary care hospital (2004-2013) with a discharge diagnosis of AH (ICD-9 code 571.1). Patients meeting criteria for AH diagnosis and with total bilirubin >5 mg/dL formed the study population. Chi-squareD and t-tests were used for comparing categorical and continuous variables, respectively. Multivariate logistic regression models were built to compare DF, MELD, and GAHS in predicting in-hospital (IHM) and 30-day mortality. Results: A total of 105 AH patients (mean age 48±10 years, 66% males, 81% white, 56% underlying cirrhosis) were reviewed. Average (mean±SD) DF, MELD, and GAHS were 54±32, 25±10, and 8±2, respectively. About 79% patients had severe AH with DF ≥32 and/or hepatic encephalopathy (HE). A total of 52 (50%) received treatment with steroids (n=29), pentoxifylline (13), or both (n=10). A total of 17 (16%) had infections with sepsis in 11 and SBP in 7 (1 with sepsis). A total of 51 (49%) died within 30 days of initial hospitalization with 26 (25%) dying during the hospitalization with an average hospital stay of about 15 days. Non-survivors compared to 79 surviving the hospitalization differed for age (51±10 vs. 47±11 years, P=0.07), HE (100% vs. 32%, P<0.0001), white cell count (16±10 vs. 12±8, P=0.02), DF (68±27 vs. 50±33, P=0.01), MELD (30±8 vs. 24±10, P=0.006), and GAHS (9±1 vs. 8±2, P=0.003). On logistic regression analysis adjusting for age, sex, underlying cirrhosis, treatment, accuracy of DF, MELD, and GAHS were similar in predicting IHM with c statistic of 0.728, 0.726, and 0.729, respectively. The scores were also similar in predicting 30-day mortality. For independently predicting the IHM and 30-day mortality, GAHS was superior to DF and MELD with OR (95% CI) of 0.68 (0.47-0.98) vs. 0.99 (0.97-1.001) vs. 0.95 (0.9-0.99) and 0.69 (0.5-0.92) vs.0.99 (0.97-0.999) vs. 0.94 (0.9-0.99), respectively. Conclusion: Discriminant function, MELD score, and GAHS are similar in predicting in-hospital and 30-day mortality in alcoholic hepatitis patients. Studies are needed to refine and improve the existing scores in predicting severity of alcoholic hepatitis.

A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90-day) mortality. We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 to January 2008 with features of AH and developed a histologic scoring system to determine the risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the United States and Europe, and a semiquantitative scoring system called the Alcoholic Hepatitis Histologic Score (AHHS) was developed. The system was validated in an independent set of 109 patients. Interobserver agreement was evaluated by weighted κ statistical analysis. The degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis, and presence of megamitochondria were independently associated with 90-day mortality. We used these 4 parameters to develop the AHHS to identify patients with a low (0-3 points), moderate (4-5 points), or high (6-9 points) risk of death within 90 days (3%, 19%, and 51%, respectively; P < .0001). The AHHS estimated 90-day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71-0.83). Interrater agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections. We identified histologic features associated with the severity of AH and developed a patient classification system that might be used in clinical decision making.

Extracorporeal liver support in severe alcoholic hepatitis.

The severity of alcoholic hepatitis (AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.

The Breathprints in Patients With Liver Disease Identify Novel Breath Biomarkers in Alcoholic Hepatitis

Selected-ion flow-tube mass spectrometry can precisely identify trace gases in the human breath, in the parts-per-billion range. We investigated whether concentrations of volatile compounds in breath samples correlate with the diagnosis of alcoholic hepatitis (AH) and the severity of liver disease in patients with AH. We recruited patients with liver disease from a single tertiary care center. The study population was divided between those with AH with cirrhosis (n = 40) and those with cirrhosis with acute decompensation from etiologies other than alcohol (n = 40); individuals without liver disease served as control subjects (n = 43). We used selected-ion flow-tube mass spectrometry to identify and measure 14 volatile compounds in breath samples from fasted subjects. We used various statistical analyses to compare clinical characteristics and breath levels of compounds among groups and to test the correlation between levels of compounds and severity of liver disease. Logistic regression analysis was performed to build a predictive model for AH. We identified 6 compounds (2-propanol, acetaldehyde, acetone, ethanol, pentane, and trimethylamine [TMA]) whose levels were increased in patients with liver disease compared with control subjects. Mean concentrations of TMA and pentane (TAP) were particularly high in breath samples from patients with AH, compared with those with acute decompensation or control subjects (for both, P < .001). Using receiver operating characteristic curve analysis, we developed a model for the diagnosis of AH based on breath levels of TAP. TAP scores of 36 or higher identified the patients with AH (area under the receiver operating characteristic curves = 0.92) with 90% sensitivity and 80% specificity. The levels of exhaled TMA had a low level of correlation with the severity of AH based on model for end-stage liver disease score (r = 0.38; 95% confidence interval, 0.07-0.69; P = .018). Based on levels of volatile compounds in breath samples, we can identify patients with AH vs patients with acute decompensation or individuals without liver disease. Levels of exhaled TMA moderately correlate with the severity of AH. These findings might be used in diagnosis of AH or in determining patient prognosis.

The utility of scoring systems in predicting early and late mortality in alcoholic hepatitis: whose score is it anyway?

Background. Alcoholic hepatitis (AH) is a distinct clinical entity in the spectrum of alcoholic liver disease with a high short-term mortality. Several scoring systems are being used to assess the severity of AH but the ability of these scores to predict long-term survival in these patients is largely unknown. Aims. We aim to assess the utility of five different scoring systems Child Pugh (CP), model for end-stage liver disease (MELD), Maddrey's discriminant function (mDF), Glasgow AH score (GAHS), and age-bilirubin-INR-creatinine (ABIC) score in predicting shot-term and long-term survival in patients with AH. Methods. Patients with histological evidence of AH were identified from our database. The clinical and biochemical parameters were used to calculate the 5 different scores. The prognostic utility of these scores was determined by generating an ROC curve for survival at 30 days, 90 days, 6 months, and 1 year. Results and Conclusions. All 5 scores with the exception of CP score have a similar accuracy in predicting the short-term prognosis. However, they are uniformly poor in predicting longer-term survival with AUROC not exceeding 0.74. CP score is a very poor predictor of survival in both short and long term. Abstinence from alcohol was significantly (P < 0.05) associated with survival at 1 year.

PWE-058 The utility of scoring systems in predicting early and late mortality in alcoholic hepatitis: whose score is it anyway?: Abstract PWE-058

<h3>Introduction</h3> Alcoholic hepatitis (AH) is considered a distinct clinical entity in the spectrum of alcoholic liver disease (ALD) with a high short-term mortality. Hence, a number of scoring systems have been developed to assess severity of AH and identify the subgroup of subjects with particularly poor outcome, and suitable for specific treatments or clinical trials. Ability of these models to predict long-term survival is unknown. <h3>Methods</h3> Aims: To assess the utility of different published scoring systems in assessing short-term (30 and 90 days) and long-term (6 and 12 months) mortality in patients with AH. <b>Methods</b> We identified patients with liver biopsy evidence of AH from the histology database: 2004–2007. Clinical and histological data were collected from all the electronic records system and from patient notes. The Child Pugh (CP) score, Maddrey discriminant function (mDF), Glasgow AH score (GAHS), Lille model, age, bilirubin, INR, creatinine (ABIC) score, Model of End Stage Liver Disease (MELD) (including its modifications), and UK End-Stage Liver Disease (UKELD) scores were calculated. We evaluated at 30 days, 90 days, 6 months and 1-year outcome. Prognostic utility of the various scores were determined by generating a receiver operating characteristic curve (ROC curve). <h3>Results</h3> Of 140 subjects who had transjugular liver biopsy in the study period, 44 had histological evidence of AH. In this subgroup cumulative 30-day mortality was 11.4% (5/44), 90-day mortality was 13.9% (6/43), 6-month mortality was 21.9% (9/41) and 1-year mortality was 26.8% (11/41). Abstract 058 gives the area under ROC curve (AUROC) and 95% CI for the various scoring systems for predicting short and long-term mortality. Abstinence from alcohol (in the first 3 months after diagnosis of AH) was significantly associated with survival at 1 year (p&lt;0.05) and predicted survival with an AUROC of 0.83 (95% CI 0.71 to 0.95) <h3>Conclusion</h3> Most scoring systems with the exception of the C-P score appear to be similar in predicting the short-term (30 and 90 days) survival in patients with AH, but were uniformly poor at predicting survival beyond 6 months. Abstinence from drinking within the first 3 months is a better predictor of survival at 1 year.

Infliximab monotherapy for severe alcoholic hepatitis and predictors of survival: An open label trial

Severe alcoholic hepatitis (AH) is associated with very high mortality. Tumor necrosis factor-alpha (TNF-alpha) contributes to the progression of AH and TNF-alpha antagonists like infliximab may help in ameliorating the severity and complications of AH. There is a scarcity of data regarding the safety and efficacy of infliximab monotherapy in the treatment of AH. We evaluated infliximab monotherapy in patients with severe AH. Patients with severe AH (Maddrey's score>32) received a single dose of infliximab 5 mg/kg IV. The primary endpoint was survival assessed at one and two months. The secondary endpoints were reduction of the Maddrey's DF and development of any bacterial infections. Predictors of survival were assessed at admission and at day 7. Nineteen patients were enrolled in the study and received infliximab. By the end of one month two patients died resulting in 1-month survival of 17/19 (89%). By the end of two months four additional patients died resulting in 2-month survival of 68%. At the end of one and two months, compared to baseline, there was significant improvement in median values of Maddrey's DF (p<0.05). Median serum TNF-alpha levels decreased from 45 (range 11-19,880) at baseline to 20 (range 4-8600) pg/mL at 4 weeks (p=0.001). CRP levels, MELD score, and absolute neutrophil count decreased significantly. Five patients (26%) developed infection: three of them had pneumonia, while two developed a flare of pulmonary tuberculosis. Three patients recovered with treatment but two patients (10%) died (one with pneumonia leading to sepsis and the other of disseminated tuberculosis). Absence of hepatic encephalopathy at admission significantly predicted survival. Among patients who survived only 1/13 (8%) had hepatic encephalopathy at admission while among patients who died 4/6 (67%) had hepatic encephalopathy (p=0.017). Lille score and delta bilirubin at day 7 (DBD7) (defined as [baseline serum bilirubin minus serum bilirubin at day 7] x 100/baseline serum bilirubin), also predicted 2-month mortality. The area under ROC curve of DBD7 values for predicting survival was 0.77 (95% CI 0.55-0.99). DBD7 of >7.5% best predicted survival in the patients (sensitivity 85%, specificity 67%, PPV 85%, NPV 67%, and overall accuracy 79%). In severe AH, single dose infliximab is associated with improvement in parameters of severity and survival. However, infection remains a concern. Hepatic encephalopathy at admission, Lille score and DBD7 predicted 2-month mortality. Large randomized controlled trials are needed before infliximab can be recommended for AH.

Serum C-reactive protein: A non-invasive marker of alcoholic hepatitis

Objective. To determine the diagnostic accuracy of C-reactive protein (CRP) for alcoholic hepatitis in heavy drinkers. Material and methods. A total of 101 heavy drinkers (67 M, 34 F) with elevated transaminase activity and negative HBsAg, anti-HCV and anti-HIV antibodies were included in the study. All patients underwent standard liver function tests, CRP determination and liver biopsies. None of the patients had signs of infection or inflammatory disease and none of them were taking antibiotics. The severity of alcoholic hepatitis was assessed semi-quantitatively using a Metavir-derived scoring system. The receiver operating curve (ROC) for CRP was constructed to assess different areas under the curve (AUCs) and the best threshold value for predicting alcoholic hepatitis (an AUC of 1.0 for an ideal test and of 0.5 for a less indicative test). Results. Pathological signs of alcoholic hepatitis were found in 29 patients (30%) and significant fibrosis (F > 1) in 46 (45.1%). CRP increased significantly with the severity of acute alcoholic hepatitis (p<0.001). Total bilirubin (OR = 1.03 CI 95% (1.01–1.06), p=0.04) and CRP (OR = 1.1 CI 95% (1.02–1.19), p=0.01) were independent factors for predicting alcoholic hepatitis. The area under the ROC curve of CRP was 0.78. Using optimized cut-off values (CRP > 19 mg/L), the sensitivity, specificity, positive, negative predictive value and diagnostic accuracy were 41%, 99%, 92%, 81% and 82%, respectively. Conclusion. CRP is an accurate marker of alcoholic hepatitis.

Circulating concentrations of interleukin‐18, interleukin‐18 binding protein, and γ interferon in patients with alcoholic hepatitis

Alcoholic hepatitis (AH) is associated with dysregulated inflammatory and immune responses. interleukin-18 (IL-18), described as gamma interferon (gammaIFN)-inducible factor, and its natural antagonist, IL-18 binding protein (IL-18 BP), has not been fully studied in patients with AH. Thus, our aim was: (i) to determine plasma values of IL-18, IL-18 BP, gammaIFN, and tumor necrosis factor alpha (TNF)-alpha in patients hospitalized for biopsy-proven AH; (ii) to correlate these cytokines with the severity of AH, as assessed by Maddrey's discriminant function (DF), the degree of liver failure using the Child-Pugh score and blood neutrophils; (iii) to compare cytokines values in survivors and non-survivors. Cytokines were measured using specific immunoassays within 7 days of admission. The diagnosis of AH was based on histology in all cases. We studied 43 cirrhotic patients with a Maddrey's DF>/=32 (severe AH), 29 patients with a score <32 (non-severe AH), 12 patients with abstinent alcoholic cirrhosis, and 10 healthy subjects. IL-18 and TNFalpha were increased in severe AH as compared with healthy subjects. Plasma IL-18 BP was elevated in patients with severe and non-severe AH as compared with healthy subjects. gammaIFN did not differ between groups. In patients with severe and non-severe AH, IL-18, IL-18 BP, TNFalpha, but not gammaIFN, were positively correlated to DF and Child-Pugh score. Neither IL-18 nor IL-18 BP correlated to TNFalpha. Patients who died (n=10) during the hospitalization had higher IL-18 BP and TNFalpha at admission as compared with survivors (322 [172-504] vs 222 [109-441] ng/ml; 7.5 [2.2-17.3] vs 3 [0.6-20] pg/ml, P<0.01, respectively). In cirrhotic patients with AH, IL-18, IL-18 BP, and TNFalpha correlate to the hepatitis severity and to the degree of liver failure. High IL-18 BP and TNFalpha at hospital admission in non-survivors suggest it may be of prognostic value.

Usefulness of technetium-99m-GSA liver scintigraphy for assessment of severity of alcoholic hepatitis

Usefulness of technetium-99m-GSA liver scintigraphy for assessment of severity of alcoholic hepatitis

31Phosphorus nuclear magnetic resonance spectroscopy: What does it tell us about alcohol-induced liver disease?

1. Patients with a history of alcohol abuse were studied by 31P n.m.r. spectroscopy of the liver in vivo, and the results were related to the pattern of disease assessed by standard biochemical and histological techniques. 2. The ratios of metabolites measured from the 31P n.m.r. spectra were abnormal in patients with alcoholic hepatitis but not in those with fatty change or cirrhosis in the absence of hepatitis. In particular, the levels of phosphomonoesters were raised, with respect either to Pv, or to adenosine 5′-triphosphate. The level of phosphomonoesters showed a significant positive correlation with the severity of alcoholic hepatitis, assessed by histology. 3. The ratio of Pi to adenosine 5′-triphosphate was used as a measure of the energy status of the hepatocytes, and was unchanged between patients and controls.

A study of patients with alcoholic liver disease by 31P nuclear magnetic resonance spectroscopy

1. Patients with a history of alcohol abuse were studied by 31P n.m.r. spectroscopy of the liver in vivo, and the results were related to the pattern of disease assessed by standard biochemical and histological techniques. 2. The ratios of metabolites measured from the 31P n.m.r. spectra were abnormal in patients with alcoholic hepatitis but not in those with fatty change or cirrhosis in the absence of hepatitis. In particular, the levels of phosphomonoesters were raised, with respect either to Pi, or to adenosine 5'-triphosphate. The level of phosphomonoesters showed a significant positive correlation with the severity of alcoholic hepatitis, assessed by histology. 3. The ratio of Pi to adenosine 5'-triphosphate was used as a measure of the energy status of the hepatocytes, and was unchanged between patients and controls.