Patricia P Bloom1,2,3, Amirkasra Mojtahed4,5, Emily D Bethea6,7,4, Sally A Knooihuizen7,4, Jin Choi6, Jules L Dienstag6,7,4, Raymond T Chung6,7,4, Chin Hur8. 1. Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit St, Blake 4, Boston, MA, USA. ppbloom@partners.org. 2. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. ppbloom@partners.org. 3. Department of Medicine, Harvard Medical School, Boston, MA, USA. ppbloom@partners.org. 4. Department of Medicine, Harvard Medical School, Boston, MA, USA. 5. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. 6. Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit St, Blake 4, Boston, MA, USA. 7. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 8. Department of Medicine, Columbia University Irving Medical Center and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Abstract
BACKGROUND: Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models. AIMS: Our aim was to identify CT features that predict outcomes in AH. METHODS: We studied 108 patients retrospectively with definite or probable AH, who underwent admission abdominal CT. A radiologist blinded to outcome evaluated eight CT features. The primary outcome was 90-day mortality. RESULTS: Twenty-five (23.2%) patients died within 90 days. While traditional prognostic tools, including Maddrey discriminant function (DF), predicted 90-day mortality (OR 1.01 [1.00, 1.03], P = 0.02), abdominal CT findings were also accurate predictors. On abdominal CT, patients with severe AH had larger volume of ascites (moderate/large volume: 34.0 vs. 8.2%, P < 0.0001), longer liver length (17.1 vs. 15.1 cm, P = 0.001), greater liver heterogeneity (moderate/severe: 21.3 vs. 8.2%, P = 0.007), and more likely to have splenomegaly (42.6 vs. 18.0%, P = 0.009) than those with mild AH. Univariate analysis revealed that ascites volume (OR 2.59 [1.35, 4.96], P = 0.004) predicted 90-day mortality. In multivariate analysis, degree of ascites predicted 90-day mortality when controlling for Maddrey DF (OR 2.36 [1.19, 4.69], P = 0.01) and trended toward significance when controlling for MELD score (OR 2.02 [0.95, 4.30], P = 0.07). CONCLUSION: CT findings in AH differentiate disease severity and predict 90-day mortality; therefore, the role of CT warrants further investigation as a tool in AH management.
BACKGROUND: Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models. AIMS: Our aim was to identify CT features that predict outcomes in AH. METHODS: We studied 108 patients retrospectively with definite or probable AH, who underwent admission abdominal CT. A radiologist blinded to outcome evaluated eight CT features. The primary outcome was 90-day mortality. RESULTS: Twenty-five (23.2%) patientsdied within 90 days. While traditional prognostic tools, including Maddrey discriminant function (DF), predicted 90-day mortality (OR 1.01 [1.00, 1.03], P = 0.02), abdominal CT findings were also accurate predictors. On abdominal CT, patients with severe AH had larger volume of ascites (moderate/large volume: 34.0 vs. 8.2%, P < 0.0001), longer liver length (17.1 vs. 15.1 cm, P = 0.001), greater liver heterogeneity (moderate/severe: 21.3 vs. 8.2%, P = 0.007), and more likely to have splenomegaly (42.6 vs. 18.0%, P = 0.009) than those with mild AH. Univariate analysis revealed that ascites volume (OR 2.59 [1.35, 4.96], P = 0.004) predicted 90-day mortality. In multivariate analysis, degree of ascites predicted 90-day mortality when controlling for Maddrey DF (OR 2.36 [1.19, 4.69], P = 0.01) and trended toward significance when controlling for MELD score (OR 2.02 [0.95, 4.30], P = 0.07). CONCLUSION: CT findings in AH differentiate disease severity and predict 90-day mortality; therefore, the role of CT warrants further investigation as a tool in AH management.
Authors: Jai Young Cho; Kyung-Suk Suh; Hae Won Lee; Eung-Ho Cho; Sung Hoon Yang; Yong Beom Cho; Nam-Joon Yi; Min A Kim; Ja-June Jang; Kuhn Uk Lee Journal: Liver Transpl Date: 2006-09 Impact factor: 5.799
Authors: Ewan H Forrest; Stephen R Atkinson; Paul Richardson; Steven Masson; Stephen Ryder; Mark R Thursz; Michael Allison Journal: J Hepatol Date: 2017-11-21 Impact factor: 25.083
Authors: E H Forrest; C D J Evans; S Stewart; M Phillips; Y H Oo; N C McAvoy; N C Fisher; S Singhal; A Brind; G Haydon; J O'Grady; C P Day; P C Hayes; L S Murray; A J Morris Journal: Gut Date: 2005-08 Impact factor: 23.059