Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity

Dai, Dao Fu; Swanson, Paul E.; Krieger, Eric V.; Liou, Iris; Carithers, Robert L.; Yeh, Matthew M.

doi:10.1038/modpathol.2014.79

Cited by 101 publications

(98 citation statements)

References 15 publications

(15 reference statements)

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“…In addition, our study revealed the presence of mononuclear inflammation in the portal tracts and lobules in approximately 53% and 36% of cases, respectively. The overall finding is consistent with previous reports [1-4, 7]. In line with previous observations, only four of 36 (11%) liver biopsies from our cohort of congestive heart failure showed cirrhosis [2, 6].…”

Section: Discussionsupporting

confidence: 94%

“…A total of 36 liver biopsies taken from patients with clinically and radiographically confirmed congestive heart failure were subjected to detailed histology review by four liver pathologists for the features listed in Table 1 and using criteria described previously [7]. When there was no consensus for a feature, it was categorized as indeterminate.…”

Section: Resultsmentioning

confidence: 99%

“…All cases that were analyzed meet the criteria. Histologic features of congestive hepatopathy and other common liver histologic parameters were reviewed, including evaluation of the overall fibrosis (stage) using a recently developed CHFS [7] (Table 1). Briefly, based on the pattern of fibrosis, scores of 0, 1, 2A, 2B, 3, and 4 were assigned as follows: score 0, no fibrosis; score 1, central fibrosis; score 2A, central zone and portal fibrosis, with accentuation of fibrosis in the central zone; score 2B, moderate portal fibrosis and central zone fibrosis, with accentuation of fibrosis in the portal zone; score 3, bridging fibrosis; score 4, cirrhosis.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, staging liver biopsies in this type of clinical setting is challenging, although progression to advanced-stage disease (cardiac cirrhosis) remains rare despite the common manifestation of centrilobular fibrosis in patients with CH [2, 6]. Recently, one study proposed a congestive hepatic fibrosis score (CHFS) as a novel histologic assessment of clinical severity [7]. However, the interobserver agreement of this scoring system has not been tested in clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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Histology and Glutamine Synthetase Immunoreactivity in Liver Biopsies From Patients With Congestive Heart Failure

et al. 2017

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BackgroundLong-standing congestive heart failure can induce a constellation of histopathology changes in the liver that can range from mild sinusoidal dilation to advanced fibrosis and loss of normal perivenular expression of glutamine synthetase (GS). Liver biopsies might be performed to assess the perioperative risk of these patients or to determine the need of synchronous liver transplant. We aimed to assess interobserver agreement in recognizing these liver histologic features in patients undergoing evaluation for heart transplantation and to examine whether immunohistochemistry of GS will aid the diagnosis of cardiac hepatopathy (CH).MethodsHematoxylin-eosin and trichrome-stained slides from 36 liver biopsies from patients undergoing evaluation for heart transplantation were reviewed by four liver pathologists. Histologic features of CH were reviewed and an overall fibrosis (stage) was assessed according to a recently proposed congestive hepatic fibrosis score (CHFS). In addition, 24 liver biopsies with a consensus diagnosis of CH and eight liver biopsies with no significant pathological changes were subjected to immunohistochemistry for GS. The Fleiss’ kappa coefficient (K) analysis was performed to determine the interobserver agreement. Further, histologic features of CH were correlated with the staining pattern of GS.ResultsSinusoidal dilation, centrilobular hepatocyte atrophy, centrilobular fibrosis and hemorrhage were the most common findings in this cohort with a substantial-to-fair level of interobserver agreement among four reviewers. The overall agreement on the diagnosis of CH and CHFS was moderate (K = 0.55, 95% confidence interval (CI): 0.32 - 0.73) and fair (K = 0.35, 95% CI: 0.24 - 0.49), respectively. Twelve (of 24, 50%) cases of CH showed loss of the normal perivenular GS staining, while the remaining 12 cases of CH and all eight controls showed retained GS expression. Histologic features of CH (presence of sinusoidal dilation, centrilobular hepatocyte atrophy, hemorrhage, and centrilobular fibrosis) and the stage of fibrosis (CHFS) were not correlated with the loss of GS staining.ConclusionMost common features of CH can be interpreted with fair-to-substantial level of agreement by liver pathologists, with an overall moderate level agreement for the diagnosis and fair agreement for CHFS. Loss of normal perivenular expression of GS only occurs in 50% CH and thus is not a sensitive marker for CH.

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Section: Discussionsupporting

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Histology and Glutamine Synthetase Immunoreactivity in Liver Biopsies From Patients With Congestive Heart Failure

et al. 2017

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“…Inter-reader variability of liver pathology has not been adequately assessed in patients with advanced heart failure, and refinement of hepatic fibrosis scoring has only recently been proposed. 15 The current studies 13,14 raise several important questions that should direct future investigation. Liver biopsy is an invasive procedure that is unlikely to become a routine part of the pre-transplant evaluation.…”

mentioning

confidence: 97%