Histological subclassification of cirrhosis based on histological-haemodynamic correlation.
BACKGROUND
Determining a relationship between specific histological parameters in cirrhosis and hepatic venous pressure gradient can be used to subclassify cirrhosis.


OBJECTIVE
To determine the relationship between hepatic venous pressure gradient and specific histological parameters in cirrhosis.


METHODS
Forty-seven patients (mean age: 46.2 +/- 13.6 years; 36 male) with biopsy-proven cirrhosis and hepatic venous pressure gradient measurements within 1 month of biopsy were studied. The following histological parameters were scored semiquantitatively: nodule size, loss of portal tracts and central veins, portal inflammation, periportal inflammation, bile duct proliferation, lobular inflammation, ballooning, fatty change, cholestasis and septal thickness.


RESULTS
On multiple ordinal regression analysis, small nodule size (odds ratio: 21.0; 95% confidence interval: 2.1-208.2, P = 0.009) and thick septa (OR: 42.6; CI: 2.3-783.7, P = 0.011) were significantly associated with the presence of clinically significant portal hypertension. A score was assigned to each of the two parameters (nodule size: large = 1, medium = 2, small = 3 and septal thickness: thin = 1, medium = 2, thick = 3). Two subcategories were devised based on the composite score: category A (n = 12): score 1-3 and category B (n = 35): score 4-6. On ordinal regression, subcategory B (OR: 15.5; CI: 3.3-74.2, P = 0.001) was significantly associated with clinically significant portal hypertension.


CONCLUSIONS
Small nodularity and thick septa are independent predictors of the presence of clinically significant portal hypertension.
Kumar
M
M
Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
Sakhuja
P
P
Kumar
A
A
Manglik
N
N
Choudhury
A
A
Hissar
S
S
Rastogi
A
A
Sarin
S K
SK
D000328:Adult; D018450:Disease Progression; D005260:Female; D006503:Hepatic Veins / Q000502:physiology*; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000145:classification* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D012720:Severity of Illness Index; D014690:Venous Pressure / Q000502:physiology*