TY - JOUR
T1 - Histological-hemodynamic correlation in cirrhosis - A histological classification of the severity of cirrhosis
AU - Nagula, Satish
AU - Jain, Dhanpat
AU - Groszmann, Roberto J.
AU - Garcia-Tsao, Guadalupe
PY - 2006/1
Y1 - 2006/1
N2 - Background/Aims: While the definitive diagnosis of cirrhosis is histological, it is the degree of portal hypertension, as determined by the hepatic venous pressure gradient (HVPG), that is an important determinant of the severity of cirrhosis. An HVPG ≥10 mmHg (termed clinically significant portal hypertension or CSPH) is predictive of the development of complications of cirrhosis, including death. This study aimed to determine the relationship between specific histological parameters and HVPG in cirrhosis. Methods: Forty-three patients with biopsy-proven cirrhosis and HVPG measurements within 6 months of the biopsy were included in the study. The following parameters were scored semiquantitatively and without knowledge of HVPG results: sinusoidal fibrosis, septal thickness, loss of portal tracts and central veins, nodule size, inflammation, steatosis, and iron. Results: Septal thickness (p=0.03), small nodularity (p=0.003), loss of portal tracts (p=0.01), inflammation (p=0.04) and alcoholic etiology (p=0.01) correlated with the presence of CSPH. However, small nodularity and septal thickness were the only parameters independently predictive of CSPH (r=0.658, p<0.05). Conclusions: We describe a subclassification of histological cirrhosis based on the severity of portal hypertension that consists of a combination of nodule size and septal thickness, with small nodularity and thick septa being independent predictors of the presence of CSPH.
AB - Background/Aims: While the definitive diagnosis of cirrhosis is histological, it is the degree of portal hypertension, as determined by the hepatic venous pressure gradient (HVPG), that is an important determinant of the severity of cirrhosis. An HVPG ≥10 mmHg (termed clinically significant portal hypertension or CSPH) is predictive of the development of complications of cirrhosis, including death. This study aimed to determine the relationship between specific histological parameters and HVPG in cirrhosis. Methods: Forty-three patients with biopsy-proven cirrhosis and HVPG measurements within 6 months of the biopsy were included in the study. The following parameters were scored semiquantitatively and without knowledge of HVPG results: sinusoidal fibrosis, septal thickness, loss of portal tracts and central veins, nodule size, inflammation, steatosis, and iron. Results: Septal thickness (p=0.03), small nodularity (p=0.003), loss of portal tracts (p=0.01), inflammation (p=0.04) and alcoholic etiology (p=0.01) correlated with the presence of CSPH. However, small nodularity and septal thickness were the only parameters independently predictive of CSPH (r=0.658, p<0.05). Conclusions: We describe a subclassification of histological cirrhosis based on the severity of portal hypertension that consists of a combination of nodule size and septal thickness, with small nodularity and thick septa being independent predictors of the presence of CSPH.
KW - Cirrhosis
KW - Hepatic venous pressure gradient
KW - Liver biopsy
KW - Portal hypertension
UR - http://www.scopus.com/inward/record.url?scp=28844504265&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2005.07.036
DO - 10.1016/j.jhep.2005.07.036
M3 - Article
C2 - 16274836
AN - SCOPUS:28844504265
SN - 0168-8278
VL - 44
SP - 111
EP - 117
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 1
ER -