Emmanuel Tsochatzis1, Sara Bruno2, Graziella Isgro1, Andrew Hall2, Eleni Theocharidou1, Pinelopi Manousou2, Amar P Dhillon2, Andrew K Burroughs3, Tu Vinh Luong4. 1. The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK. 2. Department of Histopathology, UCL Medical School, Royal Free Campus, UK. 3. The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK. Electronic address: Andrew.Burroughs@nhs.net. 4. Department of Histopathology, UCL Medical School, Royal Free Campus, UK. Electronic address: tuvinh.luong@nhs.net.
Abstract
BACKGROUND & AIMS: One-year survival in cirrhosis ranges from 1 to 57% depending on the clinical stage. Accurate sub-classification has important prognostic implications but there is no stage beyond cirrhosis using current qualitative histological systems. We compared the performance of all histological semi-quantitative and quantitative methods specifically developed for sub-classifying cirrhosis that have been described to date, with collagen proportionate area (CPA), to evaluate how well they distinguish patients with and without hepatic clinical decompensation at presentation, and in predicting future decompensating events. METHODS: We included consecutive patients with a histological diagnosis of cirrhosis that had a suitable liver biopsy between 2003 and 2007. We used semi-quantitative histological scoring systems proposed by Laennec, Kumar, and Nagula. We also measured quantitatively nodule size, septal width and fibrous tissue expressed in CPA. RESULTS: Sixty-nine patients, mean age 52.3±11years, mean MELD 11.8±5.8, median follow-up 56months. Main aetiologies were alcohol (38%) and hepatitis C (27.5%). Twenty-four patients (34.8%) had had a previous episode of clinical decompensation. Amongst the 45 patients who were compensated, 11 (24%) decompensated on follow-up. In Cox regression, amongst all histological parameters, CPA was the only variable independently associated with clinical decompensation up to the time of biopsy, with an odds ratio that ranged from 1.245 to 1.292. Furthermore, only CPA was significantly associated with future decompensation (OR: 1.117, 95% CI 1.020-1.223; p=0.017). CONCLUSIONS: Cirrhosis can be accurately sub-classified using quantification of fibrosis with CPA, and furthermore CPA is the only independent predictor of clinical decompensation amongst all other histological sub-classification systems described to date.
BACKGROUND & AIMS: One-year survival in cirrhosis ranges from 1 to 57% depending on the clinical stage. Accurate sub-classification has important prognostic implications but there is no stage beyond cirrhosis using current qualitative histological systems. We compared the performance of all histological semi-quantitative and quantitative methods specifically developed for sub-classifying cirrhosis that have been described to date, with collagen proportionate area (CPA), to evaluate how well they distinguish patients with and without hepatic clinical decompensation at presentation, and in predicting future decompensating events. METHODS: We included consecutive patients with a histological diagnosis of cirrhosis that had a suitable liver biopsy between 2003 and 2007. We used semi-quantitative histological scoring systems proposed by Laennec, Kumar, and Nagula. We also measured quantitatively nodule size, septal width and fibrous tissue expressed in CPA. RESULTS: Sixty-nine patients, mean age 52.3±11years, mean MELD 11.8±5.8, median follow-up 56months. Main aetiologies were alcohol (38%) and hepatitis C (27.5%). Twenty-four patients (34.8%) had had a previous episode of clinical decompensation. Amongst the 45 patients who were compensated, 11 (24%) decompensated on follow-up. In Cox regression, amongst all histological parameters, CPA was the only variable independently associated with clinical decompensation up to the time of biopsy, with an odds ratio that ranged from 1.245 to 1.292. Furthermore, only CPA was significantly associated with future decompensation (OR: 1.117, 95% CI 1.020-1.223; p=0.017). CONCLUSIONS:Cirrhosis can be accurately sub-classified using quantification of fibrosis with CPA, and furthermore CPA is the only independent predictor of clinical decompensation amongst all other histological sub-classification systems described to date.
Authors: Jeanne M Horowitz; Sudhakar K Venkatesh; Richard L Ehman; Kartik Jhaveri; Patrick Kamath; Michael A Ohliger; Anthony E Samir; Alvin C Silva; Bachir Taouli; Michael S Torbenson; Michael L Wells; Benjamin Yeh; Frank H Miller Journal: Abdom Radiol (NY) Date: 2017-08
Authors: Iris Y Zhou; Veronica Clavijo Jordan; Nicholas J Rotile; Eman Akam; Smitha Krishnan; Gunisha Arora; Hema Krishnan; Hannah Slattery; Noah Warner; Nathaniel Mercaldo; Christian T Farrar; Jeremy Wellen; Robert Martinez; Franklin Schlerman; Kenneth K Tanabe; Bryan C Fuchs; Peter Caravan Journal: Radiology Date: 2020-04-28 Impact factor: 11.105
Authors: Zobair M Younossi; Rohit Loomba; Mary E Rinella; Elisabetta Bugianesi; Giulio Marchesini; Brent A Neuschwander-Tetri; Lawrence Serfaty; Francesco Negro; Stephen H Caldwell; Vlad Ratziu; Kathleen E Corey; Scott L Friedman; Manal F Abdelmalek; Stephen A Harrison; Arun J Sanyal; Joel E Lavine; Philippe Mathurin; Michael R Charlton; Naga P Chalasani; Quentin M Anstee; Kris V Kowdley; Jacob George; Zachary D Goodman; Keith Lindor Journal: Hepatology Date: 2018-07 Impact factor: 17.425