ObjectivesAlcoholic hepatitis (AH) is a frequent precipitating event for the development of acute-on-chronic liver failure (ACLF), a syndrome characterised by organ failures due to immune... Show moreObjectivesAlcoholic hepatitis (AH) is a frequent precipitating event for the development of acute-on-chronic liver failure (ACLF), a syndrome characterised by organ failures due to immune dysfunction. The histological features of this complication are not well characterized. We investigated whether ACLF has specific histological characteristics.MethodsProspective cohort study in consecutive adult patients admitted between 03-2008 and 04-2021 to a tertiary referral centre with suspected AH. Diagnosis of AH was based on clinical presentation and confirmed by transjugular liver biopsy. All biopsies were assessed by a dedicated liver pathologist, blinded for clinical data and outcome. Diagnosis of ACLF was based on EASL-CLIF criteria. Histological and clinical characteristics of patients with and without ACLF at baseline were compared.Results184 patients with biopsy-proven AH were enrolled. Median time from hospital admission to transjugular biopsy was 4.5 days (IQR 2-8). At baseline, ACLF was present in 73 patients (39.7%). Out of the 110 patients without ACLF at baseline, 30 (27.3%) developed ACLF within 28 days (median 7.5 days (IQR 2-20)). At baseline, ductular bilirubinostasis (DB) was the only histological feature significantly more frequently present in patients with ACLF compared to patients without ACLF (50.7% vs. 30.6%, p = 0.003). No clear association between histological features and the development of ACLF later on could be demonstrated.ConclusionsIn this well-defined cohort of patients with biopsy-proven AH, DB was associated with the presence of ACLF. This finding fits with the pathophysiology of this syndrome, which is characterized by systemic inflammation and an increased risk of infections. Show less
Information on prognosis is essential for any physician for providing information to the patient and forms the basis for the decision-making process for therapy. Due to the heterogeneity of the... Show moreInformation on prognosis is essential for any physician for providing information to the patient and forms the basis for the decision-making process for therapy. Due to the heterogeneity of the disease, exploration of prognostic biomarkers in cirrhosis is a challenging, but important aspect of research in the field of chronic liver disease. Besides identifying patients who are at the highest risk of mortality, identification of reliable prognostic biomarkers may also help to improve treatment strategies. The aim of this thesis is to explore novel prognostic biomarkers throughout different stages of chronic liver disease and in acute-on-chronic liver failure (ACLF). Show less
Mookerjee, R.P.; Pavesi, M.; Thomsen, K.L.; Mehta, G.; Macnaughtan, J.; Bendtsen, F.; ... ; CANONIC Study Investigatos 2016
