Document Detail

The role of liver biopsy in the diagnosis and prognosis of patients with acute deterioration of alcoholic cirrhosis.
MedLine Citation:
PMID:  21376092     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: The aim of this study was to systematically assess the diagnostic and prognostic value of early liver biopsy in patients who require hospital admission with acute deterioration of alcoholic cirrhosis.
METHODS: Sixty-eight patients with acute deterioration of alcoholic cirrhosis underwent a liver biopsy within 7 days and the biopsies were processed using routine stains and K8/18 immunohistochemistry to characterize balloon degeneration. The biopsies were scored by two independent histopathologists using pre-defined criteria. The patients were managed according to institutional protocols and followed until the time of hospital discharge or death.
RESULTS: With use of K8/18 immunohistochemistry, very high concordance rate for the diagnosis of balloon degeneration was reached (r = 0.7; p = 0.0001). The presence of a systemic inflammatory response (SIRS) suggestive of acute alcoholic steatohepatitis (ASH), predicts severe ASH histologically in only 50% patients. Moreover, in 41% of SIRS negative patients who were thought not to have ASH, a diagnosis of ASH was subsequently confirmed on histological grading. Patients that have SIRS criteria but no evidence of histological ASH are more likely to develop infection which may be indicated by the severity of canalicular cholestasis. Nineteen patients died during follow up. Patients manifesting ASH on biopsy who were also SIRS positive, had a significantly greater risk of mortality compared to those that were SIRS positive but ASH negative (p < 0.01) and those that were SIRS negative (p < 0.0001).
CONCLUSIONS: The use of K8/18 immunostaining allows grading of the severity of alcoholic steatohepatitis. Early liver biopsy in these patients presenting with acute deterioration of cirrhosis is safe and provides important diagnostic and prognostic information.
Rajeshwar P Mookerjee; Caroline Lackner; Rudolf Stauber; Vanessa Stadlbauer; Moesha Deheragoda; Ariane Aigelsreiter; Rajiv Jalan
Publication Detail:
Type:  Journal Article     Date:  2011-03-02
Journal Detail:
Title:  Journal of hepatology     Volume:  55     ISSN:  1600-0641     ISO Abbreviation:  J. Hepatol.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-19     Completed Date:  2012-03-06     Revised Date:  2012-08-24    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1103-11     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
UCL Institute of Hepatology, UCL Medical School, Royal Free Hospital, United Kingdom.
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MeSH Terms
Acute Disease
Analysis of Variance
Disease Progression
Fatty Liver, Alcoholic / complications*,  mortality,  pathology*
Kaplan-Meier Estimate
Keratin-18 / immunology
Keratin-8 / immunology
Liver Cirrhosis, Alcoholic / complications*,  mortality,  pathology*
Middle Aged
Portal Pressure
ROC Curve
Severity of Illness Index
Systemic Inflammatory Response Syndrome / complications*
Reg. No./Substance:
0/Keratin-18; 0/Keratin-8
Comment In:
J Hepatol. 2012 Jun;56(6):1427-8; author reply 1428-9   [PMID:  22310696 ]

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