ABSTRACT

BACKGROUND:

Active alcoholic liver disease (AALD) is a severe liver problem characterized clinically by ascites, jaundice and poor survival. The Maddrey discriminant function can delineate AH patients who are unlikely to survive. Quantitative hepatic function measured as PHM (perfused hepatic mass) by quantitative liver spleen scan (QLSS) estimates the functional mass of the liver (AmJGastro;92:2054) and predicts clinical outcomes HALT-C (2012;Hepat;55:1019). We hypothesize the PHM will predict those who would die with AALD.

HYPOTHESIS:

HEPATIQ measured volumes and PHM by automated QLSS image analysis will allow prediction of death and clinical evolution of AALD.

PATIENTS:

1. 20 with AALD studied serially by Quantitative Liver Spleen Scan (QLSS).

2. Liver Disease: Ascites 20, HE 10, SBP 3, HRS 4, death 10

3. Abstinence: 3 Patients relapsed with jaundice/ascites after > 1 yr of abstinence and  1 Patient 3 episodes (> 1 yr abstinence between episodes).

RESULTS:

1. PHM improved  in survivors (Figure 1).
2. Liver Volume (fLV) improved before hepatic function (PHM) during recovery (Figure 2).
3. Baseline PHM < 60 determined survival (Figure 3).
4. An individual patient illustrates the consistency of this pattern (Figure 4) with 3 separate episodes of alcoholic hepatitis.
5. Portal Hypertension was common (increased fSV) and improved from 4.4 to 2.8 cc/lb IBW (P < .05 to paired t-test) with abstinence

CONCLUSION:

1. Active ALD/Alcoholic hepatitis is a dynamic condition with outcomes related to baseline PHM and fLV.
2. Hepatic volume decreases before hepatic function improves.
3. With abstinence, hepatic function and hepatic volume can rapidly improve in those surviving > 2 M.
4. Splenomegaly can markedly improve suggesting that Portal hypertension is decreasing as well.
5. The QLSS is a useful clinical tool in AALD predicting death and monitoring recovery.

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