title: The need for histological subclassification of cirrhosis: a systematic review and meta-analysis.
abstract: The need for further histological subclassification of cirrhosis has been increasingly recognized because of the heterogeneity of severity within cirrhosis. We sought to identify evidence in the literature regarding the histological subclassification of cirrhosis using the Laennec stage.
  
  
  
  We conducted a systematic review and meta-analysis by searching databases, including MEDLINE, EMBASE and the COCHRANE library, for relevant studies.
  
  
  
  Of 208 studies identified, 16 were eligible according to the inclusion criteria. With higher grades of the Laennec stage, clinical stages of cirrhosis and Child-Pugh scores/Model for end-stage liver disease scores increased (P < 0.05). Higher Laennec stages were statistically associated with the development of liver-related events, such as liver-related death, liver cancer progression and variceal haemorrhage, as well as higher hepatic venous pressure gradients and higher liver stiffness values (P < 0.05). Two open-labelled studies showed the usefulness of the Laennec system with regard to the evaluation of whether antifibrotic treatments were effective. The mean kappa value was 0.81 (range 0.61-0.87) for inter-observer agreement.
  
  
  
  Based on this systematic review and meta-analysis, histological subclassification of cirrhosis using the Laennec system is useful to better predict prognosis and complications of portal hypertension.
authors.affiliation: Department of Nursing, Research Institute for Nursing Science, Keimyung University College of Nursing, Daegu, Korea.
authors.forename: Gaeun
authors.initials: G
authors.lastname: Kim
authors.affiliation: Liver unit, University of Calgary, Calgary, AB, Canada.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.|Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Youn Zoo
authors.initials: YZ
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Cha
authors.affiliation: Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Mee Yon
authors.initials: MY
authors.lastname: Cho
mesh_terms: D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000145:classification* / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology; D017082:Portal Pressure; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: Laennec stage; cirrhosis; systematic review and meta-analysis