Quantitative Fibrosis Estimation By Image Analysis Predicts Development Of Decompensation, Composite Events And Defines Event Free Survival In Chronic Hepatitis B Patients

2016 Human Pathology In press;

The extent of fibrosis is a major determinant of the clinical outcome in patients with chronic liver diseases. We undertook this study to explore the degree of fibrosis in baseline liver biopsies to predict clinical outcomes in chronic hepatitis B (CHB) patients. Fibrosis quantification was done by image analysis on Masson's trichrome stained sections and correlated with clinical and biochemical parameters, liver stiffness and hepatic vein pressure gradient (HVPG, n=96). Follow-up information collected related to clinical outcome. A total 964 cases analyzed. Median quantitative fibrosis (QF) was 3.7% {interquartile range (IQR): 1.6-9.7%} with substantial variation in various stages. Median QF was F0, 1% (0.7% -1.65%); F1, 3.03% (2.07-4.0%); F2, 7.1% (5.6-8.7%); F3, 12.7% (10.15-16.7%); F4, 26.9% (20.3-36.4%). QF positively correlated with METAVIR staging, liver stiffness measurement, and HVPG. Eighty-nine cases developed liver-related events: decompensation, hepatocellular carcinoma (HCC), liver transplantation and death. Cox-regression analysis after adjusting for METAVIR staging- QF, albumin and AST for composite events; QF and albumin for decompensation and only QF for HCC, were found significant predictors of clinical outcomes. QF categorized into five stages: QF1, 0-5%; QF2, 5.1-10%; QF3, 10.1-15%; QF4, 15.1-20%; QF5, > 20.1%. In patients with advanced stages of QF, a probability of event-free survival found to be low. Quantitative fibrosis in baseline liver biopsy predicts progression of the disease and disease outcome in CHB patients. QF defines the probability of event-free survival in CHB cases.

Pubmed : 27189343