Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis

Baseline clinical and biochemical parameters fail to predict non-response to steroids in severe alcoholic hepatitis patients. Liver biopsy features have not been adequately assessed for predicting response to steroid therapy in severe alcoholic hepatitis. We aimed to identify histological parameters...

Full description

Saved in:
Bibliographic Details
Published in:Virchows Archiv : an international journal of pathology 2018-04, Vol.472 (4), p.667-675
Main Authors: Shasthry, Saggere Muralikrishna, Rastogi, Archana, Bihari, Chhagan, Vijayaraghavan, Rajan, Arora, Vinod, Sharma, Manoj Kumar, Sarin, Shiv Kumar
Format: Article
Language:English
Subjects:
Balloon treatment
Biopsy
Corticoids
Corticosteroids
Data processing
Degeneration
Derivation
Hepatitis
Histology
Jaundice
Liver
Medicine
Medicine & Public Health
Original Article
Parameter identification
Parameters
Pathology
Patients
Steroid hormones
Steroids
Therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223
cites cdi_FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223
container_end_page 675
container_issue 4
container_start_page 667
container_title Virchows Archiv : an international journal of pathology
container_volume 472
creator Shasthry, Saggere Muralikrishna
Rastogi, Archana
Bihari, Chhagan
Vijayaraghavan, Rajan
Arora, Vinod
Sharma, Manoj Kumar
Sarin, Shiv Kumar
description Baseline clinical and biochemical parameters fail to predict non-response to steroids in severe alcoholic hepatitis patients. Liver biopsy features have not been adequately assessed for predicting response to steroid therapy in severe alcoholic hepatitis. We aimed to identify histological parameters, which can predict steroid response in severe alcoholic hepatitis (SAH). We analyzed histological data of 107 SAH patients (71 in a derivative and 36 in a validation cohort) who presented within 4 weeks after inset of jaundice and were prospectively treated with steroids (40 mg/day). Histopathological parameters were semi-quantitatively scored in the pre-therapy biopsies in the derivative cohort, and a histological scoring system of SAH was developed which differentiated between steroid responders (Lille score  5 for predicting steroid non-response was 0.731. Baseline histological parameters in SAH, ballooning degeneration, and Mallory-Denk bodies can reliably identify non-response to corticosteroids and help to stratify patients prior to introduction of therapy.
doi_str_mv 10.1007/s00428-018-2330-4
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2012114113</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2012114113</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223</originalsourceid><addsrcrecordid>eNp1kU1rFTEUhoMo9tr2B7iRgBs3Y3PyMZlZSlErFNzUdchkzu1NmZuMObmV-wP8385wq4IgWYSQ533PgYex1yDegxD2ioTQsmsEdI1USjT6GduAVnJ5CfucbUSvTdMqsGfsFdGDEBI6aF-yM9kbaKFVG_bzJlLNU76PwU_chxofYz1yCrkgz4kPnnCKCfkUH7HwIeaZjjz4xOeCYwyVp5yagjTnRMhr5lSx5DgSjwvja8RUif-IdccJlwrkfgp5l6cY-A5XoEa6YC-2fiK8fLrP2bdPH--ub5rbr5-_XH-4bYKysjY69BDsdmvQw2hG5dFIIY1t27EfRz1g52XXKgwyaKNR2QFUZ_V6BlRSqnP27tQ7l_z9gFTdPlLAafIJ84GcFCABNIBa0Lf_oA_5UNKy3UoZbXprVgpOVCiZqODWzSXufTk6EG515E6O3OLIrY6cXjJvnpoPwx7HP4nfUhZAngBavtI9lr-j_9_6CypFnhs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2015459753</pqid></control><display><type>article</type><title>Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis</title><source>Springer Link</source><creator>Shasthry, Saggere Muralikrishna ; Rastogi, Archana ; Bihari, Chhagan ; Vijayaraghavan, Rajan ; Arora, Vinod ; Sharma, Manoj Kumar ; Sarin, Shiv Kumar</creator><creatorcontrib>Shasthry, Saggere Muralikrishna ; Rastogi, Archana ; Bihari, Chhagan ; Vijayaraghavan, Rajan ; Arora, Vinod ; Sharma, Manoj Kumar ; Sarin, Shiv Kumar</creatorcontrib><description>Baseline clinical and biochemical parameters fail to predict non-response to steroids in severe alcoholic hepatitis patients. Liver biopsy features have not been adequately assessed for predicting response to steroid therapy in severe alcoholic hepatitis. We aimed to identify histological parameters, which can predict steroid response in severe alcoholic hepatitis (SAH). We analyzed histological data of 107 SAH patients (71 in a derivative and 36 in a validation cohort) who presented within 4 weeks after inset of jaundice and were prospectively treated with steroids (40 mg/day). Histopathological parameters were semi-quantitatively scored in the pre-therapy biopsies in the derivative cohort, and a histological scoring system of SAH was developed which differentiated between steroid responders (Lille score &lt; 0.45 at day 7) and non-responders. Seventeen of the 71 (24%) patients in the derivation cohort and 9 of 36 (25%) in the validation cohort were non-responders to steroids. In the derivation cohort, in comparison to responders, non-responders had higher severity of ballooning degeneration (BD) (mean 3.87 ± 0.91 versus 2.92 ± 1.33; p  = 0.013) and density of Mallory-Denk bodies (MD) (mean 2.27 ± 0.79 versus. 1.69 ± 0.97; p  = 0.028) on liver histology. A score derived using BD and MD (range 0–8) had high sensitivity (81%), specificity (64%), and negative predictive value (91%) in identifying patients who did not respond to steroids. The AUROC for a combined MD and BD score of &gt; 5 for predicting steroid non-response was 0.731. Baseline histological parameters in SAH, ballooning degeneration, and Mallory-Denk bodies can reliably identify non-response to corticosteroids and help to stratify patients prior to introduction of therapy.</description><identifier>ISSN: 0945-6317</identifier><identifier>EISSN: 1432-2307</identifier><identifier>DOI: 10.1007/s00428-018-2330-4</identifier><identifier>PMID: 29516163</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Balloon treatment ; Biopsy ; Corticoids ; Corticosteroids ; Data processing ; Degeneration ; Derivation ; Hepatitis ; Histology ; Jaundice ; Liver ; Medicine ; Medicine &amp; Public Health ; Original Article ; Parameter identification ; Parameters ; Pathology ; Patients ; Steroid hormones ; Steroids ; Therapy</subject><ispartof>Virchows Archiv : an international journal of pathology, 2018-04, Vol.472 (4), p.667-675</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Virchows Archiv is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223</citedby><cites>FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29516163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shasthry, Saggere Muralikrishna</creatorcontrib><creatorcontrib>Rastogi, Archana</creatorcontrib><creatorcontrib>Bihari, Chhagan</creatorcontrib><creatorcontrib>Vijayaraghavan, Rajan</creatorcontrib><creatorcontrib>Arora, Vinod</creatorcontrib><creatorcontrib>Sharma, Manoj Kumar</creatorcontrib><creatorcontrib>Sarin, Shiv Kumar</creatorcontrib><title>Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis</title><title>Virchows Archiv : an international journal of pathology</title><addtitle>Virchows Arch</addtitle><addtitle>Virchows Arch</addtitle><description>Baseline clinical and biochemical parameters fail to predict non-response to steroids in severe alcoholic hepatitis patients. Liver biopsy features have not been adequately assessed for predicting response to steroid therapy in severe alcoholic hepatitis. We aimed to identify histological parameters, which can predict steroid response in severe alcoholic hepatitis (SAH). We analyzed histological data of 107 SAH patients (71 in a derivative and 36 in a validation cohort) who presented within 4 weeks after inset of jaundice and were prospectively treated with steroids (40 mg/day). Histopathological parameters were semi-quantitatively scored in the pre-therapy biopsies in the derivative cohort, and a histological scoring system of SAH was developed which differentiated between steroid responders (Lille score &lt; 0.45 at day 7) and non-responders. Seventeen of the 71 (24%) patients in the derivation cohort and 9 of 36 (25%) in the validation cohort were non-responders to steroids. In the derivation cohort, in comparison to responders, non-responders had higher severity of ballooning degeneration (BD) (mean 3.87 ± 0.91 versus 2.92 ± 1.33; p  = 0.013) and density of Mallory-Denk bodies (MD) (mean 2.27 ± 0.79 versus. 1.69 ± 0.97; p  = 0.028) on liver histology. A score derived using BD and MD (range 0–8) had high sensitivity (81%), specificity (64%), and negative predictive value (91%) in identifying patients who did not respond to steroids. The AUROC for a combined MD and BD score of &gt; 5 for predicting steroid non-response was 0.731. Baseline histological parameters in SAH, ballooning degeneration, and Mallory-Denk bodies can reliably identify non-response to corticosteroids and help to stratify patients prior to introduction of therapy.</description><subject>Balloon treatment</subject><subject>Biopsy</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Data processing</subject><subject>Degeneration</subject><subject>Derivation</subject><subject>Hepatitis</subject><subject>Histology</subject><subject>Jaundice</subject><subject>Liver</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Original Article</subject><subject>Parameter identification</subject><subject>Parameters</subject><subject>Pathology</subject><subject>Patients</subject><subject>Steroid hormones</subject><subject>Steroids</subject><subject>Therapy</subject><issn>0945-6317</issn><issn>1432-2307</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kU1rFTEUhoMo9tr2B7iRgBs3Y3PyMZlZSlErFNzUdchkzu1NmZuMObmV-wP8385wq4IgWYSQ533PgYex1yDegxD2ioTQsmsEdI1USjT6GduAVnJ5CfucbUSvTdMqsGfsFdGDEBI6aF-yM9kbaKFVG_bzJlLNU76PwU_chxofYz1yCrkgz4kPnnCKCfkUH7HwIeaZjjz4xOeCYwyVp5yagjTnRMhr5lSx5DgSjwvja8RUif-IdccJlwrkfgp5l6cY-A5XoEa6YC-2fiK8fLrP2bdPH--ub5rbr5-_XH-4bYKysjY69BDsdmvQw2hG5dFIIY1t27EfRz1g52XXKgwyaKNR2QFUZ_V6BlRSqnP27tQ7l_z9gFTdPlLAafIJ84GcFCABNIBa0Lf_oA_5UNKy3UoZbXprVgpOVCiZqODWzSXufTk6EG515E6O3OLIrY6cXjJvnpoPwx7HP4nfUhZAngBavtI9lr-j_9_6CypFnhs</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Shasthry, Saggere Muralikrishna</creator><creator>Rastogi, Archana</creator><creator>Bihari, Chhagan</creator><creator>Vijayaraghavan, Rajan</creator><creator>Arora, Vinod</creator><creator>Sharma, Manoj Kumar</creator><creator>Sarin, Shiv Kumar</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7T7</scope><scope>7TM</scope><scope>7TO</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20180401</creationdate><title>Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis</title><author>Shasthry, Saggere Muralikrishna ; Rastogi, Archana ; Bihari, Chhagan ; Vijayaraghavan, Rajan ; Arora, Vinod ; Sharma, Manoj Kumar ; Sarin, Shiv Kumar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Balloon treatment</topic><topic>Biopsy</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>Data processing</topic><topic>Degeneration</topic><topic>Derivation</topic><topic>Hepatitis</topic><topic>Histology</topic><topic>Jaundice</topic><topic>Liver</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Original Article</topic><topic>Parameter identification</topic><topic>Parameters</topic><topic>Pathology</topic><topic>Patients</topic><topic>Steroid hormones</topic><topic>Steroids</topic><topic>Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shasthry, Saggere Muralikrishna</creatorcontrib><creatorcontrib>Rastogi, Archana</creatorcontrib><creatorcontrib>Bihari, Chhagan</creatorcontrib><creatorcontrib>Vijayaraghavan, Rajan</creatorcontrib><creatorcontrib>Arora, Vinod</creatorcontrib><creatorcontrib>Sharma, Manoj Kumar</creatorcontrib><creatorcontrib>Sarin, Shiv Kumar</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Biological Sciences</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Virchows Archiv : an international journal of pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shasthry, Saggere Muralikrishna</au><au>Rastogi, Archana</au><au>Bihari, Chhagan</au><au>Vijayaraghavan, Rajan</au><au>Arora, Vinod</au><au>Sharma, Manoj Kumar</au><au>Sarin, Shiv Kumar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis</atitle><jtitle>Virchows Archiv : an international journal of pathology</jtitle><stitle>Virchows Arch</stitle><addtitle>Virchows Arch</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>472</volume><issue>4</issue><spage>667</spage><epage>675</epage><pages>667-675</pages><issn>0945-6317</issn><eissn>1432-2307</eissn><abstract>Baseline clinical and biochemical parameters fail to predict non-response to steroids in severe alcoholic hepatitis patients. Liver biopsy features have not been adequately assessed for predicting response to steroid therapy in severe alcoholic hepatitis. We aimed to identify histological parameters, which can predict steroid response in severe alcoholic hepatitis (SAH). We analyzed histological data of 107 SAH patients (71 in a derivative and 36 in a validation cohort) who presented within 4 weeks after inset of jaundice and were prospectively treated with steroids (40 mg/day). Histopathological parameters were semi-quantitatively scored in the pre-therapy biopsies in the derivative cohort, and a histological scoring system of SAH was developed which differentiated between steroid responders (Lille score &lt; 0.45 at day 7) and non-responders. Seventeen of the 71 (24%) patients in the derivation cohort and 9 of 36 (25%) in the validation cohort were non-responders to steroids. In the derivation cohort, in comparison to responders, non-responders had higher severity of ballooning degeneration (BD) (mean 3.87 ± 0.91 versus 2.92 ± 1.33; p  = 0.013) and density of Mallory-Denk bodies (MD) (mean 2.27 ± 0.79 versus. 1.69 ± 0.97; p  = 0.028) on liver histology. A score derived using BD and MD (range 0–8) had high sensitivity (81%), specificity (64%), and negative predictive value (91%) in identifying patients who did not respond to steroids. The AUROC for a combined MD and BD score of &gt; 5 for predicting steroid non-response was 0.731. Baseline histological parameters in SAH, ballooning degeneration, and Mallory-Denk bodies can reliably identify non-response to corticosteroids and help to stratify patients prior to introduction of therapy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29516163</pmid><doi>10.1007/s00428-018-2330-4</doi><tpages>9</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0945-6317
ispartof Virchows Archiv : an international journal of pathology, 2018-04, Vol.472 (4), p.667-675
issn 0945-6317
1432-2307
language eng
recordid cdi_proquest_miscellaneous_2012114113
source Springer Link
subjects Balloon treatment
Biopsy
Corticoids
Corticosteroids
Data processing
Degeneration
Derivation
Hepatitis
Histology
Jaundice
Liver
Medicine
Medicine & Public Health
Original Article
Parameter identification
Parameters
Pathology
Patients
Steroid hormones
Steroids
Therapy
title Histological activity score on baseline liver biopsy can predict non-response to steroids in patients with severe alcoholic hepatitis
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T15%3A47%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Histological%20activity%20score%20on%20baseline%20liver%20biopsy%20can%20predict%20non-response%20to%20steroids%20in%20patients%20with%20severe%20alcoholic%20hepatitis&rft.jtitle=Virchows%20Archiv%20:%20an%20international%20journal%20of%20pathology&rft.au=Shasthry,%20Saggere%20Muralikrishna&rft.date=2018-04-01&rft.volume=472&rft.issue=4&rft.spage=667&rft.epage=675&rft.pages=667-675&rft.issn=0945-6317&rft.eissn=1432-2307&rft_id=info:doi/10.1007/s00428-018-2330-4&rft_dat=%3Cproquest_cross%3E2012114113%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c372t-4c91c7ff5ea1d5d3ae52025766d9dd4be8a2863ec2c454e37b138747474be3223%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2015459753&rft_id=info:pmid/29516163&rfr_iscdi=true