Liver volume is a prognostic indicator for clinical outcome of patients with alcoholic hepatitis

Purpose To evaluate the prognostic value of abdominal computed tomography (CT) in patients with alcoholic hepatitis (AH). Methods This ancillary study was based on data collected during a previous randomized controlled trial in patients with AH. Clinical response was defined as the improvement of the baseline MELD score ≥3 points at 3 months. All patients underwent contrast-enhanced CT of the abdomen. The following parameters were measured: (1) liver density, spleen density, and liver-to-spleen density ratio; (2) liver-to-body weight (LBW) ratio; and (3) subcutaneous fat, visceral fat, and muscular content. Improvers and non-improvers were compared with univariate, multivariate, and ROC analyses. Results were compared with a validation cohort of patients. Results Fifty-eight patients (mean age, 56 years) were analyzed, including 34 (59 %) improvers. On multivariate analysis, LBW ratio (OR = 3.73; 95 % CI, 1.65–8.46; p = 0.002) and subcutaneous fat (OR = 1.01; 95 % CI, 1.00–1.02; p = 0.022) were associated with clinical response, with AUROC curves of 0.78 ± 0.06 ( p < 0.001) and 0.66 ± 0.07 ( p = 0.043), respectively. LBW ≥2.4 % predicted response with 88 % sensitivity and 63 % specificity. In the validation cohort ( n = 42, 64 % improvers), the same cut-off value predicted response with 93 % sensitivity and 60 % specificity. Conclusions In patients suffering from AH, the liver volume appears to be a major positive prognostic factor.