Z Gastroenterol 2021; 59(08): e359
DOI: 10.1055/s-0041-1734312
POSTER
Hepatologie

Histological lesions can predict response to corticosteroids in patients with severe alcohol-related steatohepatitis

R Stauber
1   Medical University of Graz, Dept. of Internal Medicine, Graz, Austria
,
F Rainer
1   Medical University of Graz, Dept. of Internal Medicine, Graz, Austria
,
M Jager
2   Université de Paris, Hôpital Beaujon, Paris, France
,
A Horhat
3   Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania, 4Medical University of Graz, Institute of Pathology, Graz, Austria
,
P Rautou
2   Université de Paris, Hôpital Beaujon, Paris, France
,
H Stefanescu
3   Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania, 4Medical University of Graz, Institute of Pathology, Graz, Austria
,
C Lackner
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Background and Aims Liver biopsy is useful to confirm alcohol-related steatohepatitis (ASH) in patients with alcohol-related liver disease (ALD) and clinically suspected alcoholic hepatitis (AH). Current EASL guidelines recommend prednisolone for the treatment of severe AH with Maddrey´s discriminant function (MDF) ≥ 32. The aim of our study was to investigate the potential utility of histologic features of ALD for early prediction of response to corticosteroids as per Lille score.

Method We analyzed data of a multinational cohort of patients with severe AH and MDF ≥ 32. All patients underwent liver biopsy for the confirmation of clinically suspected AH and were treated with prednisolone. Morphological features of ALD including steatosis, activity (contributed by hepatocellular ballooning, Mallory Denk bodies and lobular neutrophils), canalicular and ductular cholestasis as well as fibrosis stage were assessed using the recently developed ALD-specific SALVE grading and staging system. Association of histological variables with response to steroids (Lille score < 0.45) was analyzed by Chi-square test. Logistic regression was performed to ascertain the effects of histological variables on the likelihood of response to steroids.

Results Complete data were available in 119 patients. A Lille score of < 0.45 indicating response to steroids was observed in 72 patients and was associated with steatosis grade (p = 0.037) and ductular cholestasis (p = 0.029) but not with SALVE fibrosis stage or activity. Logistic regression analysis revealed presence of ductular cholestasis (p = 0.016, OR 2.8) and steatosis grade < 2 (p = 0.047, OR 2.2) as histologic predictors of a Lille score of ≥ 0.45 indicating non-response to steroids.

Conclusion Liver biopsy may thus be used not only to confirm ASH but also to achieve early prediction of steroid efficacy thus sparing high-risk AH patients from potentially life-threatening side effects of steroid exposure.



Publication History

Article published online:
01 September 2021

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