Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling
Background & aims: Alcoholic foamy degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH), but with a specific histologic pattern. Information regarding the prevalence and prognosis of AFD is scarce and there are no tools for a noninvasive diagn...
| Autores: | , , , , , , , , , , , , , , , , , , , , , |
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| Formato: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Recursos: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositorio: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:2445/217535 |
| Acesso em linha: | https://hdl.handle.net/2445/217535 |
| Access Level: | acceso abierto |
| Palavra-chave: | Hepatopaties alcohòliques Biòpsia Histologia Supervivència Triglicèrids Alcoholic liver diseases Biopsy Histology Survival Triglycerides |
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Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular ProfilingGratacós-Ginès, JordiAvitabile, EmmaMontironi, CarlaGuillamon Thiery, AlexHernández Évole, HelenaMoreta, Maria JoséBlaya, DeliaAriño, SilviaRubio, A.B.Pérez-Guasch, MartinaCervera, MartaCarol, MartaFabrellas i Padrès, NúriaSoria, AnnaJuanola Mayos, AdriàGraupera, IsabelSancho-Bru, PauDíaz Lorca, Maria AlbaColl, MarBataller, R.Ginès i Gibert, PerePose Méndez, ElisaHepatopaties alcohòliquesBiòpsiaHistologiaSupervivènciaTriglicèridsAlcoholic liver diseasesBiopsyHistologySurvivalTriglyceridesBackground & aims: Alcoholic foamy degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH), but with a specific histologic pattern. Information regarding the prevalence and prognosis of AFD is scarce and there are no tools for a noninvasive diagnosis. Methods: A cohort of patients admitted to the Hospital Clinic of Barcelona for clinical suspicion of AH who underwent liver biopsy was included. Patients were classified as AFD, AH, or other findings, according to histology. Clinical features, histology, and genetic expression of liver biopsy specimens were analyzed. The accuracy of National Institute on Alcohol Abuse and Alcoholism criteria and laboratory parameters for differential diagnosis were investigated. Results: Of 230 patients with a suspicion of AH, 18 (8%) met histologic criteria for AFD, 184 (80%) had definite AH, and 28 (12%) had other findings. In patients with AFD, massive steatosis was more frequent and the fibrosis stage was lower. AFD was characterized by down-regulation of liver fibrosis and inflammation genes and up-regulation of lipid metabolism and mitochondrial function genes. 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 model for end-stage liver disease-matched sensitivity analysis. Serum triglyceride levels had an area under the receiver operating characteristic of 0.886 (95% CI, 0.807-0.964) for the diagnosis of AFD, whereas the National Institute on Alcohol Abuse and Alcoholism criteria performed poorly. A 1-step algorithm using triglyceride levels of 225 mg/dL (sensitivity, 0.77; specificity, 0.90; and Youden index, 0.67) is proposed for differential diagnosis. Conclusions: AFD in the setting of suspicion of AH is not uncommon. A 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.Elsevier2025202520242025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion18 p.application/pdfhttps://hdl.handle.net/2445/217535Articles publicats en revistes (Fonaments Clínics)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1016/j.cgh.2023.11.031Clinical Gastroenterology and Hepatology, 2024, vol. 22, num.4, p. 768-777https://doi.org/10.1016/j.cgh.2023.11.031cc-by (c) Gratacós-Ginès, Jordi et al., 2024http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2175352026-05-29T05:05:01Z |
| dc.title.none.fl_str_mv |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| title |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| spellingShingle |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling Gratacós-Ginès, Jordi Hepatopaties alcohòliques Biòpsia Histologia Supervivència Triglicèrids Alcoholic liver diseases Biopsy Histology Survival Triglycerides |
| title_short |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| title_full |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| title_fullStr |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| title_full_unstemmed |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| title_sort |
Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling |
| dc.creator.none.fl_str_mv |
Gratacós-Ginès, Jordi Avitabile, Emma Montironi, Carla Guillamon Thiery, Alex Hernández Évole, Helena Moreta, Maria José Blaya, Delia Ariño, Silvia Rubio, A.B. Pérez-Guasch, Martina Cervera, Marta Carol, Marta Fabrellas i Padrès, Núria Soria, Anna Juanola Mayos, Adrià Graupera, Isabel Sancho-Bru, Pau Díaz Lorca, Maria Alba Coll, Mar Bataller, R. Ginès i Gibert, Pere Pose Méndez, Elisa |
| author |
Gratacós-Ginès, Jordi |
| author_facet |
Gratacós-Ginès, Jordi Avitabile, Emma Montironi, Carla Guillamon Thiery, Alex Hernández Évole, Helena Moreta, Maria José Blaya, Delia Ariño, Silvia Rubio, A.B. Pérez-Guasch, Martina Cervera, Marta Carol, Marta Fabrellas i Padrès, Núria Soria, Anna Juanola Mayos, Adrià Graupera, Isabel Sancho-Bru, Pau Díaz Lorca, Maria Alba Coll, Mar Bataller, R. Ginès i Gibert, Pere Pose Méndez, Elisa |
| author_role |
author |
| author2 |
Avitabile, Emma Montironi, Carla Guillamon Thiery, Alex Hernández Évole, Helena Moreta, Maria José Blaya, Delia Ariño, Silvia Rubio, A.B. Pérez-Guasch, Martina Cervera, Marta Carol, Marta Fabrellas i Padrès, Núria Soria, Anna Juanola Mayos, Adrià Graupera, Isabel Sancho-Bru, Pau Díaz Lorca, Maria Alba Coll, Mar Bataller, R. Ginès i Gibert, Pere Pose Méndez, Elisa |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Hepatopaties alcohòliques Biòpsia Histologia Supervivència Triglicèrids Alcoholic liver diseases Biopsy Histology Survival Triglycerides |
| topic |
Hepatopaties alcohòliques Biòpsia Histologia Supervivència Triglicèrids Alcoholic liver diseases Biopsy Histology Survival Triglycerides |
| description |
Background & aims: Alcoholic foamy degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH), but with a specific histologic pattern. Information regarding the prevalence and prognosis of AFD is scarce and there are no tools for a noninvasive diagnosis. Methods: A cohort of patients admitted to the Hospital Clinic of Barcelona for clinical suspicion of AH who underwent liver biopsy was included. Patients were classified as AFD, AH, or other findings, according to histology. Clinical features, histology, and genetic expression of liver biopsy specimens were analyzed. The accuracy of National Institute on Alcohol Abuse and Alcoholism criteria and laboratory parameters for differential diagnosis were investigated. Results: Of 230 patients with a suspicion of AH, 18 (8%) met histologic criteria for AFD, 184 (80%) had definite AH, and 28 (12%) had other findings. In patients with AFD, massive steatosis was more frequent and the fibrosis stage was lower. AFD was characterized by down-regulation of liver fibrosis and inflammation genes and up-regulation of lipid metabolism and mitochondrial function genes. 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 model for end-stage liver disease-matched sensitivity analysis. Serum triglyceride levels had an area under the receiver operating characteristic of 0.886 (95% CI, 0.807-0.964) for the diagnosis of AFD, whereas the National Institute on Alcohol Abuse and Alcoholism criteria performed poorly. A 1-step algorithm using triglyceride levels of 225 mg/dL (sensitivity, 0.77; specificity, 0.90; and Youden index, 0.67) is proposed for differential diagnosis. Conclusions: AFD in the setting of suspicion of AH is not uncommon. A 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. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 2025 2025 2025 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/217535 |
| url |
https://hdl.handle.net/2445/217535 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Reproducció del document publicat a: https://doi.org/10.1016/j.cgh.2023.11.031 Clinical Gastroenterology and Hepatology, 2024, vol. 22, num.4, p. 768-777 https://doi.org/10.1016/j.cgh.2023.11.031 |
| dc.rights.none.fl_str_mv |
cc-by (c) Gratacós-Ginès, Jordi et al., 2024 http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
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cc-by (c) Gratacós-Ginès, Jordi et al., 2024 http://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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18 p. application/pdf |
| dc.publisher.none.fl_str_mv |
Elsevier |
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Elsevier |
| dc.source.none.fl_str_mv |
Articles publicats en revistes (Fonaments Clínics) reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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