The clinical-pathologic spectrum of alcoholic hepatitis

Abstract

Sequential clinical, laboratory and pathologic data were reviewed on 252 patients with alcoholic liver disease admitted to the medical service during a 12-month period. Without prior knowledge of the clinical or laboratory data, 37 liver biopsy and/or autopsy specimens were selected from 27 cases that satisfied the criteria for histologic alcoholic hepatitis on the basis of hepatocellular necrosis, polymorphonuclear infiltration and the presence of alcoholic hyalin (Mallory body). This distinctive “triad” plus other pathologic changes were quantitatively graded on a 4-point scale. Additionally, two histologic control groups were selected. One consisted of 19 specimens graded as 3+ cirrhosis and the other (10 specimens) as 3+ fatty metamorphosis. Neither control group contained the “triad” nor features of the other control. The highest mortality occurred in the group with the most extensive hepatocellular necrosis. Prominence of alcoholic hyalin and neutrophilic infiltration were quantitatively related to the extent of necrosis. Fatty metamorphosis was variable and prominent (3+) in only 50% of specimens with 3+ necrosis. It was not possible to distinguish alcoholic hepatitis from fatty metamorphosis or cirrhosis on the basis of clinical or laboratory data. Although this study deemphasizes the concept that alcoholic hepatitis can be recognized as a distinct clinical syndrome, attention is focused on the diagnostic specificity, prognostic value and therapeutic implications of the liver biopsy in patients with alcoholic liver disease.