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Liver surface nodularity and ascites are associated with mortality risk in acute alcohol-associated hepatitis
Alex Miller1, Benjamin Carney1, Shivani Shah1
1Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA.
Insights
Liver surface nodularity (LSN) on CT scans can predict survival in alcohol-associated hepatitis (AH). High LSN indicates portal hypertension and is linked to worse outcomes, improving prognostic models.
Area of Science:
- Hepatology
- Radiology
- Medical Prognostics
Background:
- Acute alcohol-associated hepatitis (AH) has a high mortality rate.
- Liver surface nodularity (LSN) is a validated prognostic indicator in chronic liver diseases.
- The prognostic value of LSN in AH requires further investigation.
Purpose of the Study:
- To investigate the association between CT-derived liver surface nodularity (LSN) and disease severity in patients with AH.
- To determine if LSN can predict 180-day transplant-free survival in AH.
- To evaluate the utility of LSN as a prognostic biomarker in AH.
Main Methods:
- Adult patients hospitalized with AH and available CT scans were retrospectively analyzed.
- Quantitative measurement of LSN was performed using specialized software.
- Cox regression, logistic regression, and AUROC analyses were employed to assess the relationship between LSN and survival outcomes.
Main Results:
- Patients with high LSN exhibited increased signs of portal hypertension, including encephalopathy and ascites.
- High LSN, ascites, and MELD score were independently associated with decreased 180-day transplant-free survival.
- An integrated score (AHRADS) combining LSN and ascites improved the prediction of 180-day survival compared to MELD alone.
Conclusions:
- CT-derived liver surface nodularity (LSN) is a significant radiographic biomarker for predicting 180-day transplant-free survival in patients with AH.
- The presence of ascites on CT scans is also a key radiographic predictor of survival in AH.
- Integrating LSN and ascites into prognostic models enhances their accuracy for patients with AH.
Background:
Acute alcohol-associated hepatitis (AH) is associated with high mortality. CT-derived liver surface nodularity (LSN) is a robust prognostic biomarker in other chronic liver diseases. The aim of this study was to determine relationships between LSN, disease severity, and mortality in AH.
Methods:
Adults hospitalized with AH from January 2016 to March 2020 were included if an abdominal CT was performed between 8 weeks prior to 72 h after hospitalization. LSN was measured using quantitative methods (Liver Surface Nodularity Software version 0.88, Birmingham, AL, USA). Cox proportional hazards models, logistic regression and AUROC analysis were used to examine relationships between LSN and 180-day transplant-free survival.
Results:
Of 386 patients hospitalized with AH during the study period, 230 had CT scans performed, and 205 met inclusion criteria. Mean transplant-free survival was 127 days (95% CI 118-137). Within each cohort, patients were grouped into low [LSN-LOW, N = 109 (53.2%)] and high [LSN-HIGH, N = 96 (46.8%)] LSN strata based on an optimal cutoff of 2.86 derived from unadjusted ROC curves. Patients with high LSN had features of portal hypertension, which included encephalopathy [53 (55.2%) vs. 43 (39.4%), p = 0.017], ascites on CT [81 (84.4%) vs. 69 (63.3%), p = 0.001] and portosystemic shunts [78 (81.2%) vs. 69 (63.3%), p = 0.003]. High LSN, ascites and MELD were independently associated with lower likelihood of 180-day transplant-free survival, and inclusion of a score assigning 1 point each for high LSN or ascites on CT (AHRADS score) to MELD enhanced diagnostic accuracy of AUROC for 180-day survival compared to MELD alone [AUROC 0.782 (95% CI 0.719-0.845) vs. 0.735 (0.667-0.802), p = 0.023].
Conclusions:
CT-derived factors that include LSN and ascites are radiographic biomarkers associated with 180-day transplant-free survival in alcohol-associated hepatitis.
