Alcoholic Hepatitis Histological Score (AHHS)

Prognostic Stratification of Alcoholic Hepatitis
Fibrosis Stage:
Bilirubinostasis:
 
PMN infiltration:
Megamitochondria:

Background Info

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



References
  1. 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]
  2. 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]