Validation of a Congestive Hepatic Fibrosis Scoring System

Abstract

Congestive hepatopathy is a complication of right heart failure and chronically elevated right heart pressure. Histologic findings include sinusoidal dilatation, centrilobular hepatocellular plate atrophy, and fibrosis. We performed a validation study of a recently proposed scoring system (0 to 4 scale) for congestive hepatic fibrosis on 38 liver biopsies. Glutamine synthetase immunohistochemistry was also performed, and loss of centrizonal immunoreactivity correlated with increasing fibrosis score (P<0.01). Interobserver concordance for congestive hepatic fibrosis score based on Masson trichrome stain was initially fair (Fleiss κ=0.28, weighted concordance coefficient=0.60) and significantly improved (κ=0.40, weighted concordance coefficient=0.66) following a multiheaded microscope training session and inclusion of glutamine synthetase immunohistochemistry. Average congestive hepatic fibrosis score correlated with significantly higher right atrial pressure, severity of right atrial dilation, presence of right ventricular dilation, elevated serum alanine aminotransferase, platelet counts, prothrombin time, and model for end-stage liver disease score. In conclusion, the congestive hepatic fibrosis scoring system is reproducible among pathologists and correlates with clinical and laboratory markers of congestive hepatopathy.

Congestive Hepatopathy

“…As liver disease progresses, bridging fibrosis typically extends between central veins to produce a pattern that has been name "reversed lobulation", since it contrasts to the typical fibrosis pattern found in most primary liver diseases, where bridging fibrosis occurs between portal triads (i.e., zone 1) [1]. As far as the correlation between fibrosis extension and systemic hemodynamic parameters is concerned, there are discordant results with most studies finding no correlation [11,19,[76][77][78][79]. Of note, any disorder causing hepatic venous outflow obstruction (e.g., sinusoidal obstruction syndrome or Budd-Chiari syndrome) leads to similar histological findings (Figure 6) [80].…”

“…Dai et al recently introduced a four-tiered system for histologically scoring liver fibrosis in patients with CH, the Congestive Hepatic Fibrosis Score [77]. Although this scoring system has been increasingly utilized in recent clinical outcome studies and assessed for reproducibility among pathologists, it has not yet been widely applied in the clinical setting [78]. It must be highlighted that the distribution of fibrosis throughout the liver is extremely heterogeneous in patients with CH [76,81] and it may be explained by the fibrogenic effects of intrahepatic thrombosis caused by static blood flow [29].…”

The Prognostic Value of Plasma Galectin 3 in HFrEF Depends on the Etiology of Heart Failure: a Cohort Study and Animal Experiment

“…Myocardial brosis is an important pathophysiological mechanism involved in the development and progression of chronic heart failure (CHF) [24][25][26] . Collagen synthesis by myocardial broblasts is activated in diseases such as CHF and is affected by many determinants (e.g.…”

Cardiac Hepatopathy

“…As liver disease progresses, bridging fibrosis typically extends between central veins to produce a pattern that has been name "reversed lobulation" since it contrasts to the typical fibrosis pattern found in most primary liver diseases where bridging fibrosis occurs between portal triads (i.e., zone 1) [3]. As far as the correlation between fibrosis extension and systemic hemodynamic parameters is concerned, there are discordant results with most studies finding no correlation [50,54,[86][87][88][89].…”