Introduction Clinical diagnosis of severe alcoholic hepatitis (SAH) can be unreliable and liver biopsy often problematic. Neutrophil infiltration is a key histological feature of SAH and predicts corticosteroid (CS) response (1). We assessed the use of radiolabelled leucocyte scintigraphy to diagnose SAH through in vivo imaging of hepatic neutrophil migration. Liver signals at 111In-leucocyte scintigraphy portray margination at 30min post injection (PI) and destruction at 24h PI, and are normally matched. We hypothesised that both these functions would be impaired in SAH and liver activity would increase between 30min and 24h due to neutrophil migration.
Methods 16 patients with SAH (Discriminant Function 54.8 ± 16.3, 14 biopsied), 14 with inactive alcoholic cirrhosis (Child-Pugh score 5.4 ± 0.9) and 11 controls were recruited. Abdominal gamma camera images were obtained 30min and 24h after IV injection of autologous 111In-labelled leucocytes and change in liver activity expressed as a 24 h:30 min ratio. Biopsies in SAH were stained with the granulocyte marker CD15 and parenchymal neutrophils quantified across 10 high power fields.
Results Liver activity significantly increased in SAH but was static or fell in cirrhotic and normal control groups (24h:30min liver ratio 2.18 (IQR 1.62) versus 0.97 (0.28) and 0.78 (0.15) respectively, p < 0.001). Figure 1 shows example gamma camera images. Liver activity ratios in SAH correlated with histological neutrophil infiltration (ρ = 0.571, p = 0.041) and microautoradiography demonstrated intact intrahepatic radiolabelled leucocytes as the likely source of 24h liver activity. Prominent 30min lung activity was a consistent finding in SAH, providing in vivo evidence of neutrophil priming. There was no correlation between imaging/histology and CS response, likely due to the small heterogeneous study group.
Conclusion 111In-labelled leucocyte scintigraphy is a novel technique for assessment of hepatic neutrophil migration in SAH. It has potential to be a non-invasive diagnostic tool and may help to prospectively identify those likely to respond to CS.
Disclosure of Interest None Declared
Mathurin P, Duchatelle V, Ramond MJ, et al. Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology 1996; 110:1847–53.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.