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Histologic pattern is better correlated with clinical outcomes than biochemical classification in patients with drug-induced liver injury

Tian, Q., Zhao, X., Wang, Y., Wee, A., Soon, G. S. T., Gouw, A. S. H., Li, M., Yang, R., Wang, L., Wang, Q., Duan, W., Wang, Y., Wang, X., Kong, Y., Ou, X., You, H. & Jia, J., Dec-2019, In : Modern Pathology. 32, 12, p. 1795-1805 11 p.

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  • Histologic pattern is better correlated with clinical outcomes than biochemical classification in patients with drug-induced liver injury

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DOI

  • Qiu-ju Tian
  • Xin-yan Zhao
  • Yan Wang
  • Aileen Wee
  • Gwyneth Shook Ting Soon
  • Annette S. H. Gouw
  • Min Li
  • Rui-yuan Yang
  • Lan Wang
  • Qian-yi Wang
  • Wei-jia Duan
  • Yu Wang
  • Xiao-ming Wang
  • Yuan-yuan Kong
  • Xiao-juan Ou
  • Hong You
  • Ji-dong Jia

Histologically, drug-induced liver injury could be classified into acute hepatitis, chronic hepatitis, acute cholestasis, chronic cholestasis, and cholestatic hepatitis. The correlation between these histologic patterns and long-term clinical outcomes has not been well established. Therefore, we conducted a retrospective cohort study to investigate the association of histologic patterns and long-term clinical outcomes defined as biochemical normalization, persistent abnormal liver biochemistry or death at designated time points. In this study, biochemical classification was determined by R-values; histologic injury pattern was determined by morphological features. Predictive ability of clinical outcomes by these two classifications was assessed using Receiver Operating Characteristic Curves. Logistic regression was performed to identify histologic factors associated with outcomes. Totally, 88 patients with drug-induced liver injury were included for final analysis. Biochemical and histologic classification were consistent in 50 (57%) cases. 53 (60%) cases showed biochemical normalization within 6 months, and a further 11 (13%), 16 (18%), and 6 (7%) cases within 1, 2, and 3 years, respectively. Compared with biochemical classification, histologic injury pattern had better predictive ability for abnormal biochemistry at 6 months (Areas under Receiver Operating Characteristic Curves 0.92 versus 0.60, P <0.001) and 1 year (Areas under Receiver Operating Characteristic Curves 0.94 versus 0.69, P <0.001). Interlobular bile duct loss in >25% portal areas was independently associated with abnormal biochemistry at 6 months, 1 year, and 2 years. In conclusion, histologic injury pattern is better correlated with clinical outcome at 6 months and 1 year than biochemical classification. Moderate bile duct loss is an important histologic feature associated with persistent biochemical abnormality at 6 months, 1 year, and 2 years.

Original languageEnglish
Pages (from-to)1795-1805
Number of pages11
JournalModern Pathology
Volume32
Issue number12
Publication statusPublished - Dec-2019

    Keywords

  • TERM-FOLLOW-UP, BILE-DUCT LOSS, DIAGNOSIS, POPULATION, DEFINITION

ID: 109503745