Histological subclassification of cirrhosis based on histological–haemodynamic correlation

Abstract

Background Determining a relationship between specific histological parameters in cirrhosis and hepatic venous pressure gradient can be used to subclassify cirrhosis. Aim To determine the relationship between hepatic venous pressure gradient and specific histological parameters in cirrhosis. Methods Forty‐seven patients (mean age: 46.2 ± 13.6 years; 36 male) with biopsy‐proven cirrhosis and hepatic venous pressure gradient measurements within 1 month of biopsy were studied. The following histological parameters were scored semiquantitatively: nodule size, loss of portal tracts and central veins, portal inflammation, periportal inflammation, bile duct proliferation, lobular inflammation, ballooning, fatty change, cholestasis and septal thickness. Results On multiple ordinal regression analysis, small nodule size (odds ratio: 21.0; 95% confidence interval: 2.1–208.2, P = 0.009) and thick septa (OR: 42.6; CI: 2.3–783.7, P = 0.011) were significantly associated with the presence of clinically significant portal hypertension. A score was assigned to each of the two parameters (nodule size: large = 1, medium = 2, small = 3 and septal thickness: thin = 1, medium = 2, thick = 3). Two subcategories were devised based on the composite score: category A (n = 12): score 1–3 and category B (n = 35): score 4–6. On ordinal regression, subcategory B (OR: 15.5; CI: 3.3–74.2, P = 0.001) was significantly associated with clinically significant portal hypertension. Conclusion Small nodularity and thick septa are independent predictors of the presence of clinically significant portal hypertension.