title: Collagen proportionate area is superior to other histological methods for sub-classifying cirrhosis and determining prognosis.
abstract: OBJECTIVE
  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.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.affiliation: Department of Histopathology, UCL Medical School, Royal Free Campus, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Bruno
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK.
authors.forename: Graziella
authors.initials: G
authors.lastname: Isgro
authors.affiliation: Department of Histopathology, UCL Medical School, Royal Free Campus, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hall
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Theocharidou
authors.affiliation: Department of Histopathology, UCL Medical School, Royal Free Campus, UK.
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Manousou
authors.affiliation: Department of Histopathology, UCL Medical School, Royal Free Campus, UK.
authors.forename: Amar P
authors.initials: AP
authors.lastname: Dhillon
authors.affiliation: 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.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: Department of Histopathology, UCL Medical School, Royal Free Campus, UK. Electronic address: tuvinh.luong@nhs.net.
authors.forename: Tu Vinh
authors.initials: TV
authors.lastname: Luong
mesh_terms: D000328:Adult; D001706:Biopsy; D003094:Collagen / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D006651:Histocytochemistry; D006652:Histological Techniques; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification* / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D011379:Prognosis
chemical_list: D003094:Collagen