Observer Variation in Assessment of Liver Biopsies of Alcoholic Patients

Bédossa, Pierre; Poynard, Thierry; Naveau, Sylvie; Martin, E; Agostini, Hélène; Chaput, Jean‐Claude

doi:10.1111/j.1530-0277.1988.tb00155.x

Cited by 93 publications

(60 citation statements)

References 11 publications

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“…Iron overload was assessed by Perls staining with semiquantitative score between 0 and 3. 6,7 Statistical Analysis. The relationships between fibrosis score and various risk factors were studied by using a univariate comparison followed by multivariate regression with partial correlation analysis.…”

Section: Methodsmentioning

confidence: 99%

Risk factors of fibrosis in alcohol-induced liver disease

et al. 2002

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In patients with nonalcoholic steatohepatitis (NASH), age, obesity, and diabetes mellitus are independent predictors of the degree of fibrosis. The relative risk for fibrosis adjusted for sex was also associated with increasing grade of Perls stain. The aim of this study was to determine whether the risk factors for fibrosis described in NASH are also risk factors in alcohol-induced liver disease. A total of 268 alcoholic patients with negative hepatitis B virus and hepatitis C virus serology underwent liver biopsy. Fibrosis was assessed semiquantitatively by a score fluctuating between 0 to 8. Liver iron overload was assessed by Perls staining and graded in 4 classes. We have used multivariate regression with partial correlation analysis to assess the variability of fibrosis score according to the value of 7 variables: sex, age, body mass index (BMI) in the past year before the hospitalization when the patient was asymptomatic, daily alcohol intake over the past 5 years, total duration of alcohol abuse, Perls grade, and blood glucose level. In the multivariate regression, fibrosis score was positively correlated with age (P ‫؍‬ .001), BMI (P ‫؍‬ .002), female sex (P < .05), Perls grade (P < .05), and blood glucose level (P < .05). Twenty percent of the variability of fibrosis score was explained by the 7 variables. In conclusion, after adjustment for daily alcohol intake and total duration of alcohol abuse, BMI, Perls grade, and blood glucose are also independent risk factors for fibrosis in alcohol-induced liver disease, raising therapeutic implications for the management of these patients. (HEPATOLOGY 2002;35:635-638.)

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Section: Methodsmentioning

confidence: 99%

Risk factors of fibrosis in alcohol-induced liver disease

et al. 2002

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“…There is also relatively small interobserver variation in the histological interpretation of ALD with greater agreement in samples containing more than 6 portal tracts (41). However, the practitioner is more adept at diagnosing ALD than other causes of liver disease on clinical grounds alone (42,43), but it is more difficult to precisely define the type of liver disease in alcoholic patients (44).…”

Section: Liver Biopsy In Alcoholic Liver Diseasementioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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“…Histological diagnosis of AH was based on the presence of hepatocellular necrosis and infiltration of polymorphonuclear leukocytes. 21 We excluded patients with active peptic ulcers, neoplasms, positive test for hepatitis B surface antigen, and human immunodeficiency virus antibodies. Patients were treated in all centers using the same treatment protocol.…”

Section: Patientsmentioning

confidence: 99%

“…The following clinical and biological variables were recorded at admission, and biological data were prospectively determined during the treatment period (7,14,21, and 28 days): center, age, sex, alcohol intake, presence of encephalopathy, ascites, survival, bilirubin, prothrombin time, albumin, AST, creatinine, white blood cell count, polymorphonuclear count, and DF. All patients were followed for at least 6 months.…”

Section: Clinical and Biological Datamentioning

confidence: 99%

The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids

et al. 2007

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Early identification of patients with severe (discriminant function > 32) alcoholic hepatitis (AH) not responding to corticosteroids is crucial. We generated a specific prognostic model (Lille model) to identify candidates early on for alternative therapies. Three hundred twenty patients with AH prospectively treated by corticosteroids were included in the development cohort and 118 in its validation. Baseline data and a change in bilirubin at day 7 were tested. The model was generated by logistic regression. The model combining six reproducible variables (age, renal insufficiency, albumin, prothrombin time, bilirubin, and evolution of bilirubin at day 7) was highly predictive of death at 6 months (P < 0.000001). The area under the receiver operating characteristic (AUROC) curve of the Lille model was 0.89 ؎ 0.02, higher than the Child-Pugh (0.62 ؎ 0.04, P < 0.00001) or Maddrey scores (0.66 ؎ 0.04, P < 0.00001). In the validation cohort, its AUROC was 0.85 ؎ 0.04, still higher than the other models, including MELD (0.72 ؎ 0.05, P ‫؍‬ 0.01) and Glasgow scores (0.67 ؎ 0.05, P ‫؍‬ 0.0008). Patients above the ideal cutoff of 0.45 showed a marked decrease in 6-month survival as compared with others: 25% ؎ 3.8% versus 85% ؎ 2.5%, P < 0.0001. This cutoff was able to identify approximately 75% of the observed deaths. Conclusion: In the largest cohort to date of patients with severe AH, we demonstrate that the term "nonresponder" can now be extended to patients with a Lille score above 0.45, which corresponds to 40% of cases. Early identification of subjects with substantial risk of death according to the Lille model will improve management of patients suffering from severe AH and will aid in the design of future studies for alternative therapies. (HEPATOLOGY 2007;45:1348-1354 T he treatment of severe forms of alcoholic hepatitis (AH) constitutes a major challenge in management of severe alcoholic liver disease. Before the era of the Maddrey function (DF), 1,2 clinicians faced substantial difficulties in identifying subgroups of patients with high risk of death over a short term; as a consequence, survival of untreated patients enrolled in randomized controlled trials (RCTs) ranged from 0 to 81%. 3 Since the use of DF (DF Ն 32) in several RCTs, 1,4-6 spontaneous 2-month survival has been approximately 50%. The DF clearly demonstrates the tremendous progress provided by elaborating specific prognostic functions for AH. The advantage of accurate models has been confirmed by the growing importance of the MELD score in the selection of candidates for liver transplantation. [7][8][9] In patients with DF Ն 32, several RCTs and a recent meta-analysis showed that corticosteroids improve shortterm survival. 1,5,10-14 However, novel strategies or molecules are required, in light of the fact that approximately 40% of patients die at 6 months. 15 Therefore, improvement in the prediction of mortality in severe AH is warranted. However, we lack evidence supporting the higher efficacy of new models such as MELD and Glasgow scores compa...

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Observer Variation in Assessment of Liver Biopsies of Alcoholic Patients

Cited by 93 publications

References 11 publications

Risk factors of fibrosis in alcohol-induced liver disease

Risk factors of fibrosis in alcohol-induced liver disease

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids

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