Number of portal tract macrophages correlates with the modified hepatic activity index in chronic hepatitis C infection.
The Ishak modified hepatic activity index (mHAI) is widely used to score disease activity in chronic hepatitis C infection. However, the scoring of the mHAI components is subjective and prone to interobserver variation. Liver injury results in increased numbers of portal tract macrophages, which are easily identified via periodic acid-Schiff with diastase digestion stain. Evaluation of 30 liver biopsies from patients with chronic hepatitis C revealed increasing numbers of portal tract macrophages as scores of liver inflammation increased. Specifically, the number of PASD-positive portal tract macrophages per centimeter of biopsy length correlated with the level of portal inflammation and total mHAI score, and these correlations were statistically significant (P = .039 and .029, respectively). Although the portal macrophage count appeared to correlate with the interface activity and lobular necroinflammatory score, this did not meet statistical significance (P = .073 and .079, respectively). Interobserver agreement by κ analysis was greater for the portal macrophage count than for any individual component of the mHAI score. In summary, the number of periportal ceroid-laden macrophages correlates with liver inflammation as measured using the mHAI, with better interobserver agreement. This technique may serve as a useful adjunct to the mHAI in the assessment of liver injury in hepatitis C.
San Diego Department of Pathology, University of California, 92103-8720, USA.
M K
MK
McElroy
M R
MR
Peterson
D001706:Biopsy; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008099:Liver / Q000473:pathology*; D008264:Macrophages / Q000473:pathology*; D015588:Observer Variation; D011168:Portal System / Q000473:pathology*; D012720:Severity of Illness Index