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Prognostic significance of cholestatic alcoholic hepatitis

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Abstract

Tissue cholestasis is a histologic feature in some patients with alcoholic liver disease, but its significance is unknown. We studied prospectively the clinical, laboratory, and histologic findings of 306 chronic male alcoholics in whom liver tissue was available. Tissue cholestasis permitted identification of two groups: group I, absent or mild cholestasis (239 patients), and group II, moderate to severe cholestasis (67 patients). Statistical evaluation was performed by Student's ttest and regression analyses. In patients with tissue cholestasis, 97% had elevated serum cholylglycine levels, while only 61% had significant jaundice (serum bilirubin > 5 mg/dl). In patients without tissue cholestasis, 66% had elevated serum cholylglycine and 13.5% jaundice. Highly significant statistical correlations (P <0.0001) were found between cholestasis and malnutrition, prothrombin time, AST, alkaline phosphatase, bilirubin, Maddrey's discriminant function, serum cholylglycine level, albumin, and histologic severity score. In group I, 54% survived 60 months versus 22% in group II (P <0.0001). Highly significant statistical correlations (P <0.0001) were noted between serum cholylglycine levels and the parameters enumerated earlier, but not with survival. We conclude that tissue cholestasis is a highly significant prognostic indicator of outcome in alcoholic hepatitis and is more consistently associated with bile salt retention than jaundice.

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Authors and Affiliations

  1. Veterans Affairs Medical Center, North Chicago, Illinois

    Mark Nissenbaum, Antonio Chedid, Charles Mendenhall & Peter Gartside

  2. Departments of Medicine and Pathology, University of Health Sciences/The Chicago Medical School, North Chicago, Illinois

    Mark Nissenbaum, Antonio Chedid, Charles Mendenhall & Peter Gartside

  3. College of Medicine, Veterans Affairs Hospital and University of Cincinnati, Cincinnati, Ohio

    Mark Nissenbaum, Antonio Chedid, Charles Mendenhall & Peter Gartside

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  1. Mark Nissenbaum
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  2. Antonio Chedid
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  3. Charles Mendenhall
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  4. Peter Gartside
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VA Cooperative Study Group #119

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Nissenbaum, M., Chedid, A., Mendenhall, C. et al. Prognostic significance of cholestatic alcoholic hepatitis. Digest Dis Sci 35, 891–896 (1990). https://doi.org/10.1007/BF01536804

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  • DOI: https://doi.org/10.1007/BF01536804

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