Aim: Acute alcoholic hepatitis (AAH) can be fatal, particularly when it progresses to severe alcoholic hepatitis. There are several prognostic markers, but none specifically reflects liver regenerative capacity. This study investigated the serum alpha-fetoprotein (AFP)/hepatocyte growth factor (HGF) ratio as a novel prognostic indicator for AAH.
Methods: A single-center retrospective analysis was conducted on 20 AAH patients, including 12 with severe alcoholic hepatitis, hospitalized between April 2007 and September 2023. Serum AFP and HGF levels were measured at diagnosis, and the AFP/HGF ratio was calculated. Prognostic performance was assessed using receiver operating characteristic analysis, Kaplan-Meier survival analysis, and a validation cohort of 67 non-alcohol-related liver failure cases.
Results: Receiver operating characteristic analysis demonstrated excellent prognostic performance for the AFP/HGF ratio, with an area under the curve of 0.97. Patients with high AFP/HGF ratios (≥1.86) had significantly longer overall survival than those with low ratios (<1.86; p < 0.001). The median survival time for the low-ratio group was 55 days. In severe alcoholic hepatitis patients, a high AFP/HGF ratio was also associated with significantly longer overall survival (p = 0.013). At diagnosis, surviving patients had significantly higher AFP/HGF ratios when compared with subsequently deceased patients (p = 0.005). In the non-AAH cohort, no significant difference was observed between groups, but survivors showed a trend toward higher AFP/HGF ratios.
Conclusion: The AFP/HGF ratio is a novel and highly specific prognostic marker for AAH, reflecting liver regenerative capacity. It may guide early therapeutic decisions and improve outcomes, particularly for high-risk AAH patients.
Keywords: AFP/HGF ratio; acute alcoholic hepatitis; alpha‐fetoprotein; hepatocyte growth factor; severe alcoholic hepatitis.
© 2025 Japan Society of Hepatology.