The prediction of liver decompensation using hepatic collagen deposition assessed by computer-assisted image analysis with Masson’s trichrome stain

Abstract

Background & Aim

The current pathologic system classifies structural deformation caused by hepatic fibrosis semi-quantitatively, which may lead to a disagreement among pathologists. We measured hepatic fibrosis quantitatively using collagen proportionate area (CPA) in compensated cirrhotic patients and assessed its impact on predicting the development of liver decompensation.

Method

From January 2010 to June 2018, we assessed 101 patients who went through liver biopsy and received diagnosis as compensated cirrhosis with digital image analysis of CPA. Clinical and laboratory data were collected at the baseline and at the time of the last follow-up or progression to liver decompensation (LD).

Result

The mean age was 50.8 ± 10.5 years, and the most common etiology of liver disease was chronic hepatitis B (48.5%), followed by alcoholic hepatitis (18.8%). The mean CPA was 16.91 ± 9.60%. The mean CPA values were different in patients with and without LD development (21.8 ± 11.1 vs. 15.2 ± 8.5). During the median follow-up of 60.0 months, 26 out of 101 patients experienced LD. Older age (hazard ratio [HR],1.069; p = 0.015), prolonged international normalized ratio (HR, 6.449; p = 0.019) and higher CPA (HR, 1.049; p = 0.040) were independent predictors of liver decompensation on multivariate cox-regression analysis. When patients were divided according to the optimal CPA threshold (26.8%), higher CPA predicted LD better than lower CPA. (Log-rank test: p < 0.001)

Conclusion

CPA could be a useful quantitative prognostic value for patients with compensated cirrhosis.

Keywords:

• Trichrome stain
• hepatitis B
• chronic
• collagen
• biopsy
• image processing
• computer-assisted

Acknowledgements

We thank Ji-Eun Moon (Biostatistics, SoonChunHyang University Bucheon Hospital) for statistical consultation.

Ethical approval

The study was performed under ethics approval from the Institutional Clinical Research Ethics Committee (IRB no. 2022-02-022).

Patient consent

Not applicable due to retrospective design

Authors’ contribution

Conceptualization, Writing – Original Draft: Yoo HW, Kim SG, and Kim YS, Methodology: Kim YS, Park JW, Jung MJ and Kim SG, Validation of data: Yoo HW, Jung MJ, Yoo JJ, Formal analysis: Yoo HW, Investigation: Yoo JJ, Kim SG, Kim YS, Resources: Yoo HW, Park JW, Supervision: Kim YS. Approval of final manuscript: all authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported, in part, by the SoonChunHyang University Research Fund.