Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kaeferboeck, P.
Morphologic features of alcohol-related liver disease: Correlation with clinical stages and prognostic relevance
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2019. pp. 73
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Lackner Karoline
- Stauber Rudolf
- Altmetrics:
- Abstract:
- Introduction In early stages of alcohol-related liver disease (ALD) centrilobular necroinflammation leads to pericellular collagen deposition around hepatocytes called pericellular fibrosis (PCF). Persisting injury causes septal extension of PCF linking central veins and portal tracts. Progressive fibrosis is characterized by hepatocyte loss from areas of PCF, and development of septal fibrosis (SF) resembling septa in chronic viral hepatitis. We have previously shown that SF and PCF differ with respect to prognosis: histological CRN stage >F2 predicts adverse outcome in compensated ALD while presence of PCF is associated with favorable outcome in decompensated ALD. This study aimed to investigate the association of SF and PCF, as quantified by digital image analysis on survival in compensated and decompensated ALD. Patients and Methods We investigated 166 patients with ALD (compensated, n=50; decompensated, n=116) without other causes of liver disease. Clinical and biochemical factors and date of liver-related death were retrieved from the medical history. Median follow up time was 4.3 years. SF and PCF were manually distinguished using digitized slides and Collagen proportionate areas (CPA) for total fibrosis (TF), SF, PCF and parenchymal proportionate area (PPA) were quantified using Definiens TM software. The effects of fibrosis types and PPA on 5-year survival were assessed by Kaplan-Meier analysis and log-rank test. Optimized cut offs were determined by Youden index. Results In the compensated group, TF (p=0.009) and SF (p=0.008) but not PCF predicted worse outcome; however, survival was best predicted by the PCF/SF ratio (p<0.001). In the decompensated group consisting mostly of cirrhotics, worse outcome tended to associate with SF (p=0.078) and TF (p=0.165) but was inversely associated with PCF (p=0.076). The PCF/SF ratio (p=0.001) again was a better predictor of survival than any of the individual fibrosis types. PPA was associated with outcome in compensated but not decompensated ALD (respectively p=0.017 and p=0.135). Discussion In our study we could confirm that quantitatively assessed SF and PCF are associated with different outcomes. PCF/SF ratio is a better predictor of survival than is TF, SF or PCF alone. The prognostic value of assessing fibrosis by type in ALD should be investigated in further studies.