The application of a numerical scoring system for evaluating the histological outcome in patients with chronic hepatitis B followed in long term

Abstract

A numerical scoring system was applied and compared with conventional histological classification to assess the histological outcome in 42 patients with chronic hepatitis B followed for 16 to 162 months (mean = 75 months). Four histological categories in the biopsies were assessed and scored: (i) piecemeal necrosis; (ii) lobular necrosis; (iii) portal inflammation, and (iv) fibrosis and cirrhosis. The sum of all four categories was defined as the "Histological Activity Index." Altogether, 102 liver specimens, including 2 to 4 repeats from each patient, were investigated. A good correlation was noted between a high value of the Histological Activity Index score and several liver histology as monitored by conventional terminology for chronic hepatitis. Among patients with HBeAg persistence, 8 of 14 (57%) deteriorated during follow-up as judged by an increase in the Histological Activity Index score compared to 3 of 13 (23%) of the patients with HBeAg seroconversion (0.5 less than p less than 0.1). Piecemeal necrosis has been postulated to be a predictive marker for the eventual development of cirrhosis. Here, we found that a low score for piecemeal necrosis in the initial liver biopsy was significantly less predictive of a high fibrosis score in the follow-up biopsy than was a high score for initial piecemeal necrosis (p less than 0.001). It is concluded that the scoring system used can be applied to monitor the histological long-term follow-up, especially when separated into its four constituent categories. It also offers a means of predicting a chronic hepatitis outcome.

Application of a numerical scoring system for assessment of histological outcome in patients with chronic posttransfusion non‐A, non‐B hepatitis with or without antibodies to hepatitis C

“…This notion has been questioned by Popper (21). However, in chronic posttransfusion NANB hepatitis we have found that the presence of PMN indicates a later progression of fibrosis, in analogy with our findings in chronic hepatitis B (4). The presence of fibrosis in an initial liver specimen points to further fibrotic progression in chronic posttransfusion NANB hepatitis.…”

“…The histological scoring system designed by Knodell et al provides a means of studying the prognostic significance of different histopathological parameters in serial liver biopsies (3). This scoring has been found practical in a long-term follow-up study of chronic hepatitis B where the PMN and fibrosis scores correlated well with the routine histological classification and where a high PMN score was predictive of a later progressive development of fibrosis (4). The PMN scores in liver specimens of patients with chronic posttransfusion NANB hepatitis were, however, much lower than the PMN scores in patients with chronic hepatitis B (4).…”

“…The conventional histopathological classification of liver changes into categories as chronic persistent hepatitis (CPH), CAH with or without cirrhosis (Ci) can only record major histopathological changes, whereas the histological scoring system as designed by Knodell et al seems to disclose more subtle changes over time (3,4). Intraobserver variation is common and mild CAH is often difficult to differentiate from CPH (48).…”

Hepatitis B Virus Infection and Immunopathogenesis in a Humanized Mouse Model: Induction of Human-Specific Liver Fibrosis and M2-Like Macrophages

“…Immunoreactivity was determined by incubation with DAB substrate (Pierce) or Vulcan red (Dako), and counterstained with hematoxilin [56], [58]. Liver histological activity was determined using the knodell score, which examines liver necrosis, degeneration, inflammation and fibrosis [62], [63].…”

Do serum ALAT values reflect the inflammatory activity in the liver of patients with chronic viral hepatitis?

“…This may be caused by the difficulty of quantifying inflammatory activity. Existing scoring systems like the Knodell score are not suitable, because they assess total liver damage including non-inflammatory parameters (8,9).…”