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 t test and regression analyses. In patients with tissue
cholestasis, 97% had elevated serum
cholylglycine levels, while only 61% had significant
jaundice (serum
bilirubin greater than 5 mg/dl). In patients without tissue
cholestasis, 66% had elevated serum
cholylglycine and 13.5%
jaundice. Highly significant statistical correlations (P less than 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 less than 0.0001). Highly significant statistical correlations (P less than 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.