Clin Gastroenterol Hepatol. 2023 Dec 6:S1542-3565(23)00970-9. doi: 10.1016/j.cgh.2023.11.031. Online ahead of print.

ABSTRACT

BACKGROUND: Alcoholic Foamy Degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH) but with a specific histological pattern. Information regarding prevalence and prognosis of AFD is scarce and there are no tools for non-invasive diagnosis.

METHODS: a cohort of patients admitted to Hospital Clinic of Barcelona for clinical suspicion of AH that underwent liver biopsy was included. Patients were classified in AFD, AH or other findings, according to histology. Clinical features, histology and genetic expression of liver biopsies were analyzed. Accuracy of NIAAA criteria and laboratory parameters for differential diagnosis were investigated.

RESULTS: Out of 230 patients with suspicion of AH, 18 (8%) met histological criteria for AFD, 184 (80%) had definite AH and 28 (12%) had other findings. In patients with AFD, massive steatosis was more frequent and fibrosis stage was lower. AFD was characterized by down-regulation of genes of liver fibrosis and inflammation and up-regulation of genes of lipid-metabolism and mitochondrial function. Patients with AFD had markedly better long-term survival (100% vs 57% in AFD vs AH, P=.002) despite not receiving corticosteroid treatment, even in a MELD-matched sensitivity analysis. Serum triglycerides had an AUROC of 0.886 (0.807-0.964) for the diagnosis of AFD, while NIAAA criteria performed poorly. A one-step algorithm using triglyceride levels of 225mg/dL (sensitivity 0.77, specificity 0.90, Youden 0.67) is proposed for differential diagnosis.

CONCLUSIONS: AFD in the setting of suspicion of AH is not uncommon. Differential diagnosis is important because prognosis and treatment differ largely. Triglyceride levels successfully identify most patients with AFD and may be helpful in decision-making.

PMID:38065374 | DOI:10.1016/j.cgh.2023.11.031