Drug & Device Development

Early liver biopsy important in alcoholic cirrhosis

Last Updated: 2011-03-25 13:53:21 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Early liver biopsy is indicated in patients who require hospital admission with acute deterioration of alcoholic cirrhosis, UK and Austrian researchers report in a March 2nd online paper in the Journal of Hepatology.

As Dr. Rajeshwar P. Mookerjee told Reuters Health by email, "Patients with alcoholic hepatitis have a high acute mortality and thus there is a need to accurately diagnose this clinical state."

"Early liver biopsy in patients presenting with acute deterioration of alcoholic cirrhosis is safe in units with the facilities to provide this service," he added, and it provides important confirmatory diagnostic and prognostic information.

Dr. Mookerjee of Royal Free Hospital, London, and colleagues examined the success of the approach in helping to diagnose and grade acute alcoholic steatohepatitis (ASH).

Sixty-eight patients with acute deterioration of alcoholic cirrhosis underwent a liver biopsy within 7 days of admission. The biopsies were processed using routine stains and K8/18 immunohistochemistry to characterize hepatocellular ballooning.

The team found that the presence of a systemic inflammatory response (SIRS) suggestive of ASH in 36 patients, predicted severe ASH histologically in only 50%. Moreover, in 41% of SIRS negative patients, thought not to have ASH, a diagnosis of ASH was subsequently confirmed on histological grading.

During follow-up of 28 days, 19 patients died. Most of the deaths were associated with sepsis and progressive organ failure.

Patients who had ASH on biopsy and were SIRS positive had a significantly greater risk of mortality compared to those that were SIRS positive but ASH negative. This was also true of those who were SIRS negative.

"Defining accurately the at-risk population from the larger group presenting with alcoholic cirrhosis helps target therapy to those likely to gain the most benefit (i.e. having the highest mortality without specific treatment) using interventions that carry increased risk of infection (e.g. corticosteroids)," continued Dr. Mookerjee.

"Those with cirrhosis but no liver inflammation (i.e. not alcoholic hepatitis) may benefit more from strategies such as treatment of latent infection with antibiotics," he concluded.

SOURCE: http://bit.ly/fZ3t6H

J Hepatol 2011.