Serum Bile Acid Concentrations, Histopathological Features, and Short‐, and Long‐term Survival in Horses with Hepatic Disease

Abstract

Background: Serum bile acid concentrations (SBA) and a histopathological biopsy score [Equine Vet J 35 (2003) 534] are used prognostically in equine hepatic disease.Hypothesis: Histopathologic features and scores, but not SBA, differ between survivors and nonsurvivors and correlate with histopathologic evidence of hepatic inflammation and fibrosis.Animals: Retrospective study. Records (1999Records ( -2011 of horses with hepatic disease diagnosed by biopsy and with concurrent measurements of SBA.Methods: Retrospective cohort study. Biopsies were examined for inflammatory cell infiltration including type and distribution, fibrosis, irreversible cytopathology affecting hepatocytes, hemosiderin, or other pigment deposition and bile duct proliferation. SBA, histopathological findings and a histological score [Equine Vet J 35 (2003) 534] were compared between short-(survival to discharge) and long-term (>6 months) survivors and correlations between SBA and histopathological findings investigated.Results: Of 81 cases 90% survived short-term and 83% long-term. Short-term and long-term nonsurvival were associated with SBA (P = .009; P = .006), overall (P = .001; P = .002) and parenchymal (short-term only; P = .01) inflammation, portal and bridging fibrosis (all P < .001), apoptosis or single cell necrosis (P < .001; P = .008), hemosiderin deposition in hepatocytes (P = .011; P = .028), biliary (both P < .001), vascular (P = .003; P = .045) and endothelial (P < .001; P = .02) hyperplasia, nucleic changes (P = .004; P < .001) and the histopathological score (both P < .001). SBA were significantly and positively correlated with overall (P = .001), parenchymal (P < .001) and portal (P = .004) inflammation and portal (P = .036) and bridging (P = .002) fibrosis.Conclusions and Clinical Importance: SBA, histopathological findings and scores differ between survivors and nonsurvivors. SBA concentrations are associated with inflammation and fibrosis suggesting interference with hepatic function. A histopathological score >2 and, less so, SBA >20 lmol/L are specific but not sensitive indicators of nonsurvival.

Two cases of hepatopathy and hyperferraemia managed with deferoxamine and phlebotomy

“…; Dunkel et al . ). Phlebotomy and chelation therapy have been reported to result in clinical improvement in people with increased hepatic iron concentration (Britton et al .…”

“…Irrespective of the primary contribution of iron to hepatic disease in these cases, hepatic accumulation of iron (haemosiderosis of greater than 50% hepatocytes as seen in Case 2) has been described as an independent predictor of non-survival in liver disease Dunkel et al 2015). Phlebotomy and chelation therapy have been reported to result in clinical improvement in people with increased hepatic iron concentration (Britton et al 2002;Dongiovanni et al 2011).…”

“…In horses data to support the specific role of iron in hepatic disease are limited although haemosiderin accumulation is noted in advanced liver disease and carries a poor prognosis for survival (Dunkel et al . ).…”

“…Iron depletion therapy in humans with hereditary haemochromatosis is reported to result in a decreased risk of hepatocellular carcinoma and cirrhosis (Beaton and Adams 2006;Kanwar and Kowdley 2013). In horses data to support the specific role of iron in hepatic disease are limited although haemosiderin accumulation is noted in advanced liver disease and carries a poor prognosis for survival (Dunkel et al 2015).…”

Clinical Pathology in the Adult Sick Horse

“…46 Horses with chronic liver disease and persistently increased bile acid concentrations greater than 20 mmol/L have a guarded to poor prognosis. 35,47 Bile acid concentrations should not be used as a predictor of prognosis in horses with acute liver disease.…”