Prognostic Role of Liver Biopsy in Patients With Severe Indeterminate Acute Hepatitis

Lin, Su; Araujo, Catarina; Hall, Andrew; Kumar, Rahul; Phillips, Andrew T.; Hassan, Mohsin; Engelmann, Cornelius; Quaglia, Alberto; Jalan, Rajiv

doi:10.1016/j.cgh.2021.08.008

Cited by 6 publications

(4 citation statements)

References 33 publications

(36 reference statements)

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“…Fourth, the presence or absence of massive hepatic necrosis in a liver biopsy sample depends on sampling. The predictive value of massive hepatic necrosis in our series could reflect the extent of the liver parenchyma injury increasing the chance that areas of multilobular necrosis are represented in a core biopsy sample but sampling variation is a limiting factor when interpreting liver biopsies in this context 6 …”

Section: Discussionmentioning

confidence: 95%

“…This study is part of the CARNATION study, which is a retrospective‐prospective project that aims to explore clinicopathological characteristics of patients with acute hepatitis 6 . Histological records from January 2010 to October 2019 were screened to find eligible cases at the Royal Free Hospital, London using the following texts: ‘acute hepatitis’ or ‘acute liver failure’.…”

Section: Methodsmentioning

confidence: 99%

“…Liver biopsy to determine the aetiology of patients with IAH is rarely performed because of the risk of bleeding. Our previous study showed that multilobular necrosis may be a predictive factor for poor prognosis in severe IAH 6 . In this clinicopathological study, we explored the clinical and pathological features that may be used to select patients with IAH that may benefit from corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis

Lin

Araujo

Hall

et al. 2022

Liver International

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Background and Aims Treatment of patients with severe indeterminate hepatitis (IAH) is an unmet need. Corticosteroids are often used in the management of these patients but criteria for the selection of patients for this intervention are arbitrary. The aims of this study were to analyse the clinical and pathological features of patients with IAH to define predictors of corticosteroid responsiveness. Methods This study included consecutive patients with acute indeterminate hepatitis admitted to a single hospital and underwent a liver biopsy. The clinical manifestation and histopathological features of steroid and non‐steroid groups were compared and their relationship with corticosteroids response was evaluated. Results Forty‐eight patients were included, 24 (50%) recovered and the other half underwent liver transplantation or died within 3‐months. Of the 48 cases, 24 received corticosteroids (initial dose of 45 ± 12 mg prednisolone). Corticosteroids were initiated 2.7 ± 3.8 days after admission. Liver biopsy was performed 2‐days (median, IQR 1‐3) after admission. Fifteen (62.5%) patients receiving corticosteroids survived without transplantation compared with 9 (37.5%) that did not receive steroids (P = .149). In those with multilobular necrosis, 50% reduction in the death/transplantation rate was observed after steroid treatment (P = .018). In patients without multilobular necrosis and with or without perivenulitis, corticosteroids did not impact the outcome. Response to corticosteroids was independent of the MELD score. Conclusions The presence of multilobular necrosis on liver biopsy helps identify a subgroup of IAH cases who may benefit from the administration of corticosteroids.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis

Lin

Araujo

Hall

et al. 2022

Liver International

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“…The Cox proportional hazards model was However, despite the markedly increased risk of adverse outcomes in the general population, [2] elevated BMI may also paradoxically be associated with survival benefits in specific patient populations. Higher BMI level has been reported many times as correlated with improved survival in patients with end-stage kidney disease (ESKD), [3] chronic heart failure, [4] chronic liver disease, [5] acute severe hepatitis, [6] and when admitted to intensive care units. [7] This phenomenon has been termed the "obesity paradox.…”

Section: Discussionmentioning

confidence: 99%

Fatty liver disease reverses the obesity paradox in chronic kidney disease stages 3–5: A follow‐up study of NHANES III

Huang

Zhang

et al. 2022

Hepatol Commun

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High body mass index (BMI) has been associated with better survival in patients with end-stage kidney disease. Individuals with fatty liver disease (FLD) have a higher risk of chronic kidney disease. It remains unclear whether the survival benefit of high BMI in patients with chronic kidney disease is present when there is concomitant FLD. This study used the data set from the Third American National Health and Nutrition Examination Survey and the corresponding survival data. The Cox proportional hazards model was used to evaluate the effect of BMI on mortality. A total of 12,445 participants were included. The prevalence of FLD was 39.8%. The median follow-up time (with interquartile range) was 22.8 (20.8-24.8) years. During this period, 3749 (30.1%, 14.4 of 1000 person-year) deaths were observed. Among these, 1169 (31.2%) died within the first 10 years. The Cox regression analysis showed that the BMI level was not associated with 25-year mortality in patients with decreased glomerular filtration rate (GFR < 60 ml/min/1.73 m 2 ), but 10-year mortality was significantly lower in patients with BMI ≥ 25 kg/m 2 than in those with BMI < 25 kg/m 2 (p = 0.049). Multivariate analysis showed BMI ≥ 25 kg/ m 2 was an independent protective factor for 10-year mortality (hazard ratio [HR] 0.691, 95% confidence interval [CI] 0.559-0.856; p = 0.001). This protective effect of higher BMI was lost in patients with FLD (HR 0.884, 95% CI 0.585-1.335; p = 0.557) but persisted in the non-FLD group (HR 0.625, 95%

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Validation of the SURFASA score to define steroid responsiveness in patients with acute autoimmune hepatitis

Lin

Hall

Kumar

et al. 2022

Journal of Hepatology

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Prognostic Role of Liver Biopsy in Patients With Severe Indeterminate Acute Hepatitis

Cited by 6 publications

References 33 publications

Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis

Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis

Fatty liver disease reverses the obesity paradox in chronic kidney disease stages 3–5: A follow‐up study of NHANES III

Validation of the SURFASA score to define steroid responsiveness in patients with acute autoimmune hepatitis

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