Alcoholic Hepatitis Histological Score (AHHS)
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Prognostic Stratification of
Alcoholic Hepatitis
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Fibrosis Stage:
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Bilirubinostasis:
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PMN infiltration:
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Megamitochondria:
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Background Info
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Alcoholic Hepatitis Histological Scoring system: Altamirano J, Miquel R, et al. were able to develop a novel histologic classification system based on histologic features associated with disease severity to predict short-term (90 day) mortality. Data from 121 patients with alcoholic hepatitis (AH) from January 2000 through January 2008 were studied in order to develop a prognostic model that could predict the risk of death using logistic regression. Degree of fibrosis, neutrophil infiltration, type of bilirubinostasis, and presence megamitochondria were independently associated with 90 day mortality. These 4 parameters were used to develop the AHHS score to identify patients with low (0-3 points), moderate (4-5 points), and high (6- 9 points) risks of death within 90 days (3%, 19%, and 51%, respectively; P<.0001). [1] Rahimi E, et al. noted that when combing histologic data (AHHS) with analytical scoring systems such as the MELD score, the AHHS was useful in refining the prognostic stratification of patients with a MELD score <21 (potentially changing the severity) which would lead to modifications in treatment. [2]
Key points [1]:
(direct quotes)
- Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease.
- In its
most severe form, short-term mortality of AH remains high (20-30%) probably
due to poor
patient characterization and the need for modern targeted therapies.
- Current
therapies (i.e. corticosteroids and pentoxifylline) fail in many patients and
there is
a clear need to develop new pathophysiologically-oriented approaches. Although
the
presence of AH can be suspected based on clinical and biochemical data, a
definitive
diagnosis requires histological confirmation. Regretfully, there are no
well-
validated non-invasive methods to establish the diagnosis of AH.
Scoring:
Altamirano J, Miquel R, et al. Scoring -
Alcoholic Hepatitis Histological Score (AHHS) for Prognostic Stratification of
Alcoholic Hepatitis [1].
Points
AHHS categories (0-9 points)
Fibrosis stage
None Fibrosis or Portal fibrosis 0
Expansive fibrosis 0
Bridging fibrosis or Cirrhosis +3
Bilirubinostasis
No 0
Hepatocellular only 0
Canalicular or ductular +1
Canalicular or ductular plus Hepatocellular +2
PMN infiltration
No/Mild +2
Severe PMN Infiltration 0
Megamitochondria
No Megamitochondria +2
Megamitochondria 0
Interpretation:
Mild : 0-3
Intermediate: 4-5
Severe: 6-9
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References
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- Altamirano J, Miquel R, Katoonizadeh A, Abraldes JG, Duarte-Rojo A, Louvet A,
et al. A histologic scoring system for prognosis of patients with alcoholic
hepatitis. Gastroenterology. 2014;146(5):1231-1239.e1231-1236. [Pubmed]
- Rahimi E, Pan JJ. Prognostic models for alcoholic hepatitis. Biomark Res.
2015;3:20.
Published 2015 Jul 21. doi:10.1186/s40364-015-0046-z [Pubmed]
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