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Non-Invasive Biomarkers for Differentiating Alcohol Associated Hepatitis from Acute Decompensation in Patients with
Mina Ignat1,2, Horia Stefanescu1,2
1Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", 400394 Cluj-Napoca, Romania.
Insights
Diagnosing severe alcohol-associated hepatitis (AH) is challenging. This review explores non-invasive tests to differentiate AH from decompensated cirrhosis (DC) and assess treatment response.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Alcohol-associated hepatitis (AH) is the most severe form of alcohol-related liver disease, often difficult to distinguish from decompensated cirrhosis (DC).
- Diagnosis relies on clinical and bioclinical assessments, with liver biopsy as the gold standard for atypical cases.
- AH pathogenesis involves complex interactions including gene expression, immune dysregulation, and gut microbiota alterations.
Purpose of the Study:
- To review non-invasive diagnostic and prognostic tools for alcohol-associated hepatitis (AH).
- To compare the performance of non-invasive tests in distinguishing AH from decompensated cirrhosis (DC).
- To evaluate the utility of these tests in assessing treatment response to corticotherapy.
Main Methods:
- Review of current literature on non-invasive tests for AH and DC.
- Analysis of diagnostic accuracy, prognostic value, and treatment response assessment of various biomarkers.
- Focus on emerging circulating biomarkers such as keratin 18, microRNAs, and sphingolipids.
Main Results:
- Non-invasive tests are increasingly valuable for early AH diagnosis and prognostication.
- These emerging tools align with the known pathogenesis of AH.
- Specific cut-offs and performance metrics for distinguishing AH from DC are discussed.
Conclusions:
- Non-invasive tests offer a promising alternative to liver biopsy for AH diagnosis and management.
- Circulating biomarkers show potential for improved accuracy in diagnosis, prognosis, and treatment monitoring.
- Further validation of these non-invasive tools is crucial for clinical implementation.
Abstract:
Alcohol-associated hepatitis (AH) is the most severe form of alcohol-related liver disease. The natural course of alcohol-related liver disease is influenced by heavy alcohol consumption and abstinence periods. Differentiating between AH and decompensated cirrhosis (DC) could be extremely challenging in clinical practice due to clinical and bioclinical similarities. The severity of AH is made on bioclinical grounds, the severe form necessitating corticotherapy treatment. Liver biopsy is still the standard of care for establishing the diagnosis in atypical presentations. The pathogenesis of AH is an interplay between gene expression, cytokine dysregulation, the immune system and the gut microbiota. Non-invasive tests are increasingly and widely used for the purpose of early diagnosis and reliable prognostication. The non-invasive tests are emerging in concordance with disease pathogenesis. In this review, we describe the non-invasive tools that can distinguish AH from DC. We outline the available cut-offs and their performance in diagnosis and prognosis, as well as in assessing the treatment response to corticotherapy. Promising circulating biomarkers like keratin 18, microRNAs and sphingolipids will be in the review.
