A histologic scoring system for prognosis of patients with alcoholic hepatitis

Gastroenterology. 2014 May;146(5):1231-9.e1-6. doi: 10.1053/j.gastro.2014.01.018. Epub 2014 Jan 15.


Background & aims: There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90-day) mortality.

Methods: We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 to January 2008 with features of AH and developed a histologic scoring system to determine the risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the United States and Europe, and a semiquantitative scoring system called the Alcoholic Hepatitis Histologic Score (AHHS) was developed. The system was validated in an independent set of 109 patients. Interobserver agreement was evaluated by weighted κ statistical analysis.

Results: The degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis, and presence of megamitochondria were independently associated with 90-day mortality. We used these 4 parameters to develop the AHHS to identify patients with a low (0-3 points), moderate (4-5 points), or high (6-9 points) risk of death within 90 days (3%, 19%, and 51%, respectively; P < .0001). The AHHS estimated 90-day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71-0.83). Interrater agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections.

Conclusions: We identified histologic features associated with the severity of AH and developed a patient classification system that might be used in clinical decision making.

Keywords: Alcoholic Hepatitis; Alcoholic Liver Disease; Histologic Classification; Liver Biopsy.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Bilirubin / analysis
  • Biopsy
  • Chi-Square Distribution
  • Decision Support Techniques*
  • Europe
  • Female
  • Hepatitis, Alcoholic / complications
  • Hepatitis, Alcoholic / diagnosis*
  • Hepatitis, Alcoholic / mortality
  • Hepatitis, Alcoholic / pathology
  • Humans
  • Kaplan-Meier Estimate
  • Liver / chemistry
  • Liver / pathology*
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / pathology
  • Logistic Models
  • Male
  • Middle Aged
  • Mitochondria, Liver / pathology
  • Mitochondrial Size
  • Multivariate Analysis
  • Neutrophil Infiltration
  • Observer Variation
  • Odds Ratio
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • United States


  • Bilirubin