Alcoholic hepatitis natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Alcoholic hepatitis}} | {{Alcoholic hepatitis}} | ||
{{CMG}}; | {{CMG}}; {{ AE}} {{S.M}} | ||
== Overview== | == Overview== | ||
[[Alcoholic]] [[liver disease]] may progress to [[fatty liver]], [[ hepatic]][[steatosis]], [[Alcoholic hepatitis]], [[alcoholic]] [[steatonecrosis]],[[fibrosis]], [[cirrhosis]] and [[hepatocellular carcinoma]]. [[Complications]] of [[Alcoholic hepatitis]] include [[variceal [[hemorrhage]],[[hepatic]] [[encephalopathy]],[[ascites]],[[Coagulopathy]], [[thrombocytopenia]],[[spontaneous bacterial peritonitis]], and [[iron]] overload. Different scoring systems were presented to predict the [[prognosis]] and [[mortality]] among patients with [[Alcoholic hepatitis]]. The most recent and accurate one is called Asymmetric dimethylarginine (ADMA) score. | |||
==Natural history, complication, and prognosis== | ==Natural history, complication, and prognosis== | ||
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** [[Cirrhosis]] and [[hepatocellular carcinoma]] ([[HCC]]) | ** [[Cirrhosis]] and [[hepatocellular carcinoma]] ([[HCC]]) | ||
* The [[liver]] [[biopsy]] of around 20-40% of the individuals with [[steatosis]] is suggestive of [[steatohepatitis]] | * The [[liver]] [[biopsy]] of around 20-40% of the individuals with [[steatosis]] is suggestive of [[steatohepatitis]] | ||
* After development of [[steatohepatitis]], the [[hepatic]] change is irreversible, even after the abstinence | * After development of [[steatohepatitis]], the [[hepatic]] change is [[irreversible]], even after the [[abstinence ]] | ||
* Compared to [[steatosis]], development of [[Alcoholic Hepatitis]] | ===Complication=== | ||
== | *[[Complications]] of [[Alcoholic Hepatitis]] include: <ref> {{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK470217/ |title=Alcoholic Hepatitis - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}} </ref> | ||
**[[Variceal hemorrhage]] | |||
* | **[[Hepatic]] [[encephalopathy]] | ||
* | **[[Ascites]] | ||
* | ** [[Coagulopathy]] and [[thrombocytopenia]] | ||
* | ** [[Spontaneous bacterial peritonitis]] | ||
**[[Iron overload]] | |||
* | |||
* | ===Prognosis=== | ||
* Discriminant | * Compared to [[steatosis]], development of [[Alcoholic Hepatitis]] is associated with nine -times higher risk of developing [[cirrhosis]] as well as 40 % chance of 180- days mortality.<ref name="pmid21317995">{{cite journal| author=Frazier TH, Stocker AM, Kershner NA, Marsano LS, McClain CJ| title=Treatment of alcoholic liver disease. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 1 | pages= 63-81 | pmid=21317995 | doi=10.1177/1756283X10378925 | pmc=3036962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21317995 }} </ref> | ||
* Continuing [[alcohol]] consumption can lead to development of [[cirrhosis]] in 70 % subjects with [[Alcoholic Hepatitis]]<ref name="pmid30115921">{{cite journal| author=Seitz HK, Bataller R, Cortez-Pinto H, Gao B, Gual A, Lackner C | display-authors=etal| title=Alcoholic liver disease. | journal=Nat Rev Dis Primers | year= 2018 | volume= 4 | issue= 1 | pages= 16 | pmid=30115921 | doi=10.1038/s41572-018-0014-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30115921 }} </ref> | |||
* [[Alcoholic Hepatitis]] is considered to be [[fatal]] as 1-year [[mortality]] [[rate]] among subjects is 25%. <ref name="pmid30225400">{{cite journal| author=Lourens S, Sunjaya DB, Singal A, Liangpunsakul S, Puri P, Sanyal A | display-authors=etal| title=Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study. | journal=Mayo Clin Proc Innov Qual Outcomes | year= 2017 | volume= 1 | issue= 1 | pages= 37-48 | pmid=30225400 | doi=10.1016/j.mayocpiqo.2017.04.004 | pmc=6134907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30225400 }} </ref> | |||
* The progression of precirrhotic disease to [[cirrhosis]] are reported as the following rates:<ref name="pmid31173814">{{cite journal| author=Parker R, Aithal GP, Becker U, Gleeson D, Masson S, Wyatt JI | display-authors=etal| title=Natural history of histologically proven alcohol-related liver disease: A systematic review. | journal=J Hepatol | year= 2019 | volume= 71 | issue= 3 | pages= 586-593 | pmid=31173814 | doi=10.1016/j.jhep.2019.05.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31173814 }} </ref> | |||
** 1% (0-8%) for patients with normal [[histology]] | |||
* | ** 3% (2-4%) for [[hepatic]] [[steatosis]] | ||
* | ** 10% (6-17%) for [[steatohepatitis]] | ||
* | ** 8% (3-19%) for [[fibrosis]] | ||
* | * Maddrey et al. described Discriminant Function (DF), is a [[predictor]] of [[severity]] of [[Alcoholic Hepatitis]]:<ref name="pmid20034030">{{cite journal| author=O'Shea RS, Dasarathy S, McCullough AJ, Practice Guideline Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology| title=Alcoholic liver disease. | journal=Hepatology | year= 2010 | volume= 51 | issue= 1 | pages= 307-28 | pmid=20034030 | doi=10.1002/hep.23258 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034030 }} </ref> | ||
** DF score is calculated by the following formula: | |||
***DF = 4.6 x ([[PT]] – [[control]] [[PT]]) + [[ Total]] [[Bilirubin]] | |||
** DF score > 32 is suggestive of [[severe]] [[disease]] and [[30-day]] [[mortality]] rate is 50% without [[steroids]] [[treatment]] | |||
** DF score is not an accurate system for estimating the [[mortality]] and [[prognosis]] among those who received [[treatment]] | |||
* Model for End-Stage Liver Disease (MELD) predicts [[mortality]] [[risk]] in patients with [[end-stage]] [[liver disease]]<ref name="pmid20844956">{{cite journal| author=Al Sibae MR, Cappell MS| title=Accuracy of MELD scores in predicting mortality in decompensated cirrhosis from variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, or acute liver failure as well as mortality after non-transplant surgery or TIPS. | journal=Dig Dis Sci | year= 2011 | volume= 56 | issue= 4 | pages= 977-87 | pmid=20844956 | doi=10.1007/s10620-010-1390-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20844956 }} </ref> | |||
** MELD score ≥21 within 24 hours of presentation predicts of 90-day [[mortality]] | |||
** MELD and DF scores are similar in predicting both 30-day and 90-day [[mortality]] | |||
* Glasgow Alcoholic Hepatitis Score (GAHS) is another scoring system which calculated the [[risk]] based on [[age]], [[serum]] [[bilirubin]], [[blood urea nitrogen]], [[PT]], and peripheral [[WBC]]count <ref name="pmid16009691">{{cite journal| author=Forrest EH, Evans CD, Stewart S, Phillips M, Oo YH, McAvoy NC | display-authors=etal| title=Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score. | journal=Gut | year= 2005 | volume= 54 | issue= 8 | pages= 1174-9 | pmid=16009691 | doi=10.1136/gut.2004.050781 | pmc=1774903 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16009691 }} </ref> | |||
** GASH score ≥ 9 is a [[predictor]] of [[mortality]] | |||
** GASH is more accurate than DF in predicting both 28- and 84-day [[mortality]] | |||
** GASH scoring system is similar to MELD in predicting the 28-day [[mortality]] | |||
* Asymmetric dimethylarginine (ADMA) score is the most recent predictor of [[severe]] [[Alcoholic Hepatitis]] <ref name="pmid17187433">{{cite journal| author=Mookerjee RP, Malaki M, Davies NA, Hodges SJ, Dalton RN, Turner C | display-authors=etal| title=Increasing dimethylarginine levels are associated with adverse clinical outcome in severe alcoholic hepatitis. | journal=Hepatology | year= 2007 | volume= 45 | issue= 1 | pages= 62-71 | pmid=17187433 | doi=10.1002/hep.21491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17187433 }} </ref> | |||
** ADMA score is a better [[predictor]] of [[outcomes]] of [[Alcoholic Hepatitis]] than other scoring systems | |||
==References== | ==References== | ||
Latest revision as of 22:12, 2 August 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Overview
Alcoholic liver disease may progress to fatty liver, hepaticsteatosis, Alcoholic hepatitis, alcoholic steatonecrosis,fibrosis, cirrhosis and hepatocellular carcinoma. Complications of Alcoholic hepatitis include [[variceal hemorrhage,hepatic encephalopathy,ascites,Coagulopathy, thrombocytopenia,spontaneous bacterial peritonitis, and iron overload. Different scoring systems were presented to predict the prognosis and mortality among patients with Alcoholic hepatitis. The most recent and accurate one is called Asymmetric dimethylarginine (ADMA) score.
Natural history, complication, and prognosis
Natural history
- Alcoholic liver disease may progress to one of the following stages:[1] [2]
- Fatty liver or hepaticsteatosis
- Steatohepatitis defined as Alcoholic Hepatitis or alcoholic steatonecrosis
- Fibrosis
- Cirrhosis and hepatocellular carcinoma (HCC)
- The liver biopsy of around 20-40% of the individuals with steatosis is suggestive of steatohepatitis
- After development of steatohepatitis, the hepatic change is irreversible, even after the abstinence
Complication
- Complications of Alcoholic Hepatitis include: [3]
Prognosis
- Compared to steatosis, development of Alcoholic Hepatitis is associated with nine -times higher risk of developing cirrhosis as well as 40 % chance of 180- days mortality.[4]
- Continuing alcohol consumption can lead to development of cirrhosis in 70 % subjects with Alcoholic Hepatitis[5]
- Alcoholic Hepatitis is considered to be fatal as 1-year mortality rate among subjects is 25%. [6]
- The progression of precirrhotic disease to cirrhosis are reported as the following rates:[7]
- 1% (0-8%) for patients with normal histology
- 3% (2-4%) for hepatic steatosis
- 10% (6-17%) for steatohepatitis
- 8% (3-19%) for fibrosis
- Maddrey et al. described Discriminant Function (DF), is a predictor of severity of Alcoholic Hepatitis:[8]
- Model for End-Stage Liver Disease (MELD) predicts mortality risk in patients with end-stage liver disease[9]
- Glasgow Alcoholic Hepatitis Score (GAHS) is another scoring system which calculated the risk based on age, serum bilirubin, blood urea nitrogen, PT, and peripheral WBCcount [10]
- Asymmetric dimethylarginine (ADMA) score is the most recent predictor of severe Alcoholic Hepatitis [11]
- ADMA score is a better predictor of outcomes of Alcoholic Hepatitis than other scoring systems
References
- ↑ Testino G (2008). "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepatogastroenterology. 55 (82–83): 371–7. PMID 18613369.
- ↑ Testino G (2013). "Alcoholic hepatitis". J Med Life. 6 (2): 161–7. PMC 3725441. PMID 23904876.
- ↑ "Alcoholic Hepatitis - StatPearls - NCBI Bookshelf".
- ↑ Frazier TH, Stocker AM, Kershner NA, Marsano LS, McClain CJ (2011). "Treatment of alcoholic liver disease". Therap Adv Gastroenterol. 4 (1): 63–81. doi:10.1177/1756283X10378925. PMC 3036962. PMID 21317995.
- ↑ Seitz HK, Bataller R, Cortez-Pinto H, Gao B, Gual A, Lackner C; et al. (2018). "Alcoholic liver disease". Nat Rev Dis Primers. 4 (1): 16. doi:10.1038/s41572-018-0014-7. PMID 30115921.
- ↑ Lourens S, Sunjaya DB, Singal A, Liangpunsakul S, Puri P, Sanyal A; et al. (2017). "Acute Alcoholic Hepatitis: Natural History and Predictors of Mortality Using a Multicenter Prospective Study". Mayo Clin Proc Innov Qual Outcomes. 1 (1): 37–48. doi:10.1016/j.mayocpiqo.2017.04.004. PMC 6134907. PMID 30225400.
- ↑ Parker R, Aithal GP, Becker U, Gleeson D, Masson S, Wyatt JI; et al. (2019). "Natural history of histologically proven alcohol-related liver disease: A systematic review". J Hepatol. 71 (3): 586–593. doi:10.1016/j.jhep.2019.05.020. PMID 31173814.
- ↑ O'Shea RS, Dasarathy S, McCullough AJ, Practice Guideline Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology (2010). "Alcoholic liver disease". Hepatology. 51 (1): 307–28. doi:10.1002/hep.23258. PMID 20034030.
- ↑ Al Sibae MR, Cappell MS (2011). "Accuracy of MELD scores in predicting mortality in decompensated cirrhosis from variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, or acute liver failure as well as mortality after non-transplant surgery or TIPS". Dig Dis Sci. 56 (4): 977–87. doi:10.1007/s10620-010-1390-3. PMID 20844956.
- ↑ Forrest EH, Evans CD, Stewart S, Phillips M, Oo YH, McAvoy NC; et al. (2005). "Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score". Gut. 54 (8): 1174–9. doi:10.1136/gut.2004.050781. PMC 1774903. PMID 16009691.
- ↑ Mookerjee RP, Malaki M, Davies NA, Hodges SJ, Dalton RN, Turner C; et al. (2007). "Increasing dimethylarginine levels are associated with adverse clinical outcome in severe alcoholic hepatitis". Hepatology. 45 (1): 62–71. doi:10.1002/hep.21491. PMID 17187433.