Περίληψη:
Background & Aims: The SALVE Histopathology Group (SHG) developed and
validated a grading and staging system for the clinical and full
histological spectrum of alcohol-related liver disease (ALD) and
evaluated its prognostic utility in a multinational cohort of 445
patients.
Methods: SALVE grade was described by semiquantitative scores for
steatosis, activity (hepatocellular injury and lobular neutrophils) and
cholestasis. The histological diagnosis of steatohepatitis due to ALD
(histological ASH, hASH) was based on the presence of hepatocellular
ballooning and lobular neutrophils. Fibrosis staging was adapted from
the Clinical Research Network staging system for non-alcoholic fatty
liver disease and the Laennec staging system and reflects the pattern
and extent ALD fibrosis. There are 7 SALVE fibrosis stages (SFS) ranging
from no fibrosis to severe cirrhosis.
Results: Interobserver ic-value for each grading and staging parameter
was >0.6. In the whole study cohort, long-term outcome was associated
with activity grade and cholestasis, as well as cirrhosis with very
broad septa (severe cirrhosis) (p <0.001 for all parameters). In
decompensated ALD, adverse short-term outcome was associated with
activity grade, hASH and cholestasis (p = 0.038, 0.012 and 0.001,
respectively), whereas in compensated ALD, hASH and severe
fibrosis/cirrhosis were associated with decompensation-free survival (p
= 0.011 and 0.001, respectively). On multivariable analysis, severe
cirrhosis emerged as an independent histological predictor of long-term
survival in the whole study cohort. Severe cirrhosis and hASH were
identified as independent predictors of short-term survival in
decompensated ALD, and also as independent predictors of
decompensation-free survival in compensated ALD.
Conclusion: The SALVE grading and staging system is a reproducible and
prognostically relevant method for the histological assessment of
disease activity and fibrosis in ALD.
Lay summary: Patients with alcohol-related liver disease (ALD) may
undergo liver biopsy to assess disease severity. We developed a system
to classify ALD under the microscope by grading ALD activity and staging
the extent of liver scarring. We validated the prognostic performance of
this system in 445 patients from 4 European centers. (C) 2021 The
Authors. Published by Elsevier B.V. on behalf of European Association
for the Study of the Liver.
Συγγραφείς:
Lackner, Carolin
Stauber, Rudolf E.
Davies, Susan
Denk,
Helmut
Dienes, Hans Peter
Gnemmi, Viviane
Guido, Maria and
Miquel, Rosa
Paradis, Valerie
Schirmacher, Peter and
Terracciano, Luigi
Berghold, Andrea
Pregartner, Gudrun and
Binder, Lukas
Douschan, Philipp
Rainer, Florian
Sygulla,
Stephan
Jager, Marion
Rautou, Pierre-Emmanuel
Bumbu, Andreea
and Horhat, Adelina
Rusu, Ioana
Stefanescu, Horia
Detlefsen,
Sonke
Krag, Aleksander
Thiele, Maja
Cortez-Pinto, Helena and
Moreno, Christophe
Gouw, Annette S. H.
Tiniakos, Dina G.
