Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.73
Peer-review started: November 22, 2017
First decision: December 7, 2017
Revised: December 15, 2017
Accepted: January 9, 2018
Article in press: January 9, 2018
Published online: January 27, 2018
To explore the relationship between collagen proportionate area (CPA) and portal hypertension-related clinical manifestations in alcoholic liver disease (ALD).
Retrospective study with chart review of patients with ALD adressed to our center between January 2012 and December 2013 for a transjugular liver biopsy (TJLB) and hepatic hemodynamic study. Patients were included if they met the following criteria: (1) Medical indication for a liver biopsy in the setting of ALD; (2) recent (< 15 d) clinical, radiological, endoscopic and biological data available; and (3) estimated follow-up of at least 6 mo. Liver tissue from cirrhotic subjects obtained from transjugular liver biopsies was stained with PicroSirius red and computer-assisted digital image analysis to determine fibrosis density using CPA was performed.
We included 61 patients with alcoholic ALD, subdivided in 41 active alcohol drinkers and 20 durably abstinent patients. Nine healthy liver donors served as controls. Mean CPA in patients with ALD was 7.1%, with no difference between active drinkers and abstinent patients (P = 0.17). Using a fibrosis density cutoff of 5%, we observed a positive correlation between high fibrosis density and the hepatic venous pressure gradient (HVPG) only in active drinkers (P = 0.02). At 12-mo of follow-up, in the group of active alcohol drinkers, patients reaching a composite outcome showed a higher HVPG value as compared to those who did not (18.5 mmHg vs 14.5 mmHg P < 0.04) whereas CPA values were similar (6.9% vs 11%, P = 0.23).
In active alcoholic ALD, CPA correlates to portal pressure but only HVPG predicts clinical events, pointing to the role of alcohol as a modulator of portal hypertension.
Core tip: This is the first study exploring the relationships between fibrosis density assessed by collagen proportionate area (CPA) in liver biopsy, hepatic venous pressure gradient (HVPG) and development of clinical manifestations of portal hypertension in patients with chronic advanced alcoholic liver disease addressed for liver investigations. The results suggest a positive correlation between high fibrosis density and the HVPG only in active drinkers. HVPG, but not CPA, predicts clinical events in active alcohol drinkers pointing to the role of alcohol as a modulator of portal hypertension.