Romain Breguet1,2,3, Maxime Ronot1,3, Nicolas Goossens2,4, Catrina Hansen1,2, Emiliano Giostra2,4, Pietro Majno2,5, Christoph D Becker1,2, Laurent Spahr2,4, Sylvain Terraz6,7. 1. Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. 2. Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland. 3. Department of Radiology, University Hospitals of Beaujon, Paris, France. 4. Department of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland. 5. Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland. 6. Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. sylvain.terraz@hcuge.ch. 7. Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland. sylvain.terraz@hcuge.ch.
Abstract
PURPOSE: To evaluate the prognostic value of abdominal computed tomography (CT) in patients with alcoholic hepatitis (AH). METHODS: This ancillary study was based on data collected during a previous randomized controlled trial in patients with AH. Clinical response was defined as the improvement of the baseline MELD score ≥3 points at 3 months. All patients underwent contrast-enhanced CT of the abdomen. The following parameters were measured: (1) liver density, spleen density, and liver-to-spleen density ratio; (2) liver-to-body weight (LBW) ratio; and (3) subcutaneous fat, visceral fat, and muscular content. Improvers and non-improvers were compared with univariate, multivariate, and ROC analyses. Results were compared with a validation cohort of patients. RESULTS: Fifty-eight patients (mean age, 56 years) were analyzed, including 34 (59 %) improvers. On multivariate analysis, LBW ratio (OR = 3.73; 95 % CI, 1.65-8.46; p = 0.002) and subcutaneous fat (OR = 1.01; 95 % CI, 1.00-1.02; p = 0.022) were associated with clinical response, with AUROC curves of 0.78 ± 0.06 (p < 0.001) and 0.66 ± 0.07 (p = 0.043), respectively. LBW ≥2.4 % predicted response with 88 % sensitivity and 63 % specificity. In the validation cohort (n = 42, 64 % improvers), the same cut-off value predicted response with 93 % sensitivity and 60 % specificity. CONCLUSIONS: In patients suffering from AH, the liver volume appears to be a major positive prognostic factor.
PURPOSE: To evaluate the prognostic value of abdominal computed tomography (CT) in patients with alcoholic hepatitis (AH). METHODS: This ancillary study was based on data collected during a previous randomized controlled trial in patients with AH. Clinical response was defined as the improvement of the baseline MELD score ≥3 points at 3 months. All patients underwent contrast-enhanced CT of the abdomen. The following parameters were measured: (1) liver density, spleen density, and liver-to-spleen density ratio; (2) liver-to-body weight (LBW) ratio; and (3) subcutaneous fat, visceral fat, and muscular content. Improvers and non-improvers were compared with univariate, multivariate, and ROC analyses. Results were compared with a validation cohort of patients. RESULTS: Fifty-eight patients (mean age, 56 years) were analyzed, including 34 (59 %) improvers. On multivariate analysis, LBW ratio (OR = 3.73; 95 % CI, 1.65-8.46; p = 0.002) and subcutaneous fat (OR = 1.01; 95 % CI, 1.00-1.02; p = 0.022) were associated with clinical response, with AUROC curves of 0.78 ± 0.06 (p < 0.001) and 0.66 ± 0.07 (p = 0.043), respectively. LBW ≥2.4 % predicted response with 88 % sensitivity and 63 % specificity. In the validation cohort (n = 42, 64 % improvers), the same cut-off value predicted response with 93 % sensitivity and 60 % specificity. CONCLUSIONS: In patients suffering from AH, the liver volume appears to be a major positive prognostic factor.
Entities:
Keywords:
Alcoholic hepatitis; Body composition; Computed tomography; Prognostic factors; Volumetry
Authors: Patricia P Bloom; Amirkasra Mojtahed; Emily D Bethea; Sally A Knooihuizen; Jin Choi; Jules L Dienstag; Raymond T Chung; Chin Hur Journal: Dig Dis Sci Date: 2019-07-30 Impact factor: 3.199