title: The Laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis.
abstract: OBJECTIVE
  The clinical severity of cirrhosis varies widely. We investigated whether histological sub-classification of cirrhosis using the Laennec system can discriminate different outcomes among patients with cirrhosis.
  
  
  METHODS
  One hundred and seventy-five patients with chronic liver disease who underwent liver biopsy and showed stage 3 or 4 fibrosis between January 2001 and December 2008 were prospectively enrolled. Cirrhosis was sub-classified into three groups (4A, 4B, and 4C) according to the Laennec system. The end point was liver-related event (LRE) occurrence, including decompensation, hepatocellular carcinoma, and liver-related death.
  
  
  RESULTS
  The median age of the patients (110 men, 65 women) was 55 years. Stages 3, 4A, 4B, and 4C were identified in 46 (26.3%), 16 (9.1%), 82 (46.9%), and 31 (17.7%) patients, respectively. During the follow-up period, LREs occurred in 32 (18.3%) patients: 4 (8.7%) with stage 3, 2 (12.5%) with stage 4A, 17 (20.7%) with stage 4B, and 9 (29.0%) with stage 4C. In a multivariate analysis, histological sub-classification of cirrhosis independently predicted LRE occurrence. While patients with stage 4A tended to be at higher risk of LRE occurrence than those with stage 3, patients with stages 4B and 4C had significantly higher risks of LRE occurrence, with hazard ratios of 6.158 (p=0.016) and 8.945 (p=0.004), respectively.
  
  
  CONCLUSIONS
  Histological sub-classification of cirrhosis using the Laennec system can be used to assess the risk of LRE occurrence among patients with cirrhosis. Our study provides a solid basis for further studies of non-invasive methods for monitoring the risk of LRE occurrence and will help physicians to establish optimum treatment strategies.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Ian R
authors.initials: IR
authors.lastname: Wanless
authors.forename: Sarah
authors.initials: S
authors.lastname: Lee
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000145:classification* / Q000150:complications / Q000473:pathology*; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011517:Prothrombin Time; D018570:Risk Assessment; D012709:Serum Albumin; D012720:Severity of Illness Index; D055815:Young Adult; D000509:alpha-Fetoproteins
chemical_list: D012709:Serum Albumin; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin