Liver surface nodularity and ascites are associated with mortality risk in acute alcohol-associated hepatitis

Alex Miller; Benjamin Carney; Shivani Shah; Hui-Wei Chen; Amir Gougol; Amir Borhani; Ramon Bataller; Shahid Malik; Vikrant Rachakonda

doi:10.1111/acer.15248

Liver surface nodularity and ascites are associated with mortality risk in acute alcohol-associated hepatitis

Alcohol Clin Exp Res (Hoboken). 2024 Feb;48(2):273-282. doi: 10.1111/acer.15248. Epub 2023 Dec 29.

Authors

Alex Miller¹, Benjamin Carney¹, Shivani Shah¹, Hui-Wei Chen², Amir Gougol³, Amir Borhani⁴, Ramon Bataller⁵, Shahid Malik⁶, Vikrant Rachakonda¹

Affiliations

¹ Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, USA.
² Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
³ University of California San Francisco School of Medicine, San Francisco, California, USA.
⁴ Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁵ Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
⁶ University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

PMID: 38123167
DOI: 10.1111/acer.15248

Abstract

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.

Keywords: alcohol-associated hepatitis; ascites; liver surface nodularity score; portal hypertension.