Medical School, The University of Western Australia, Perth, Australia.
Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
Hepatol Int. 2023 Oct;17(5):1162-1169. doi: 10.1007/s12072-023-10564-3. Epub 2023 Jun 26.
Liver fibrosis predicts adverse clinical outcomes, such as liver-related death (LRD) and hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to investigate the accuracy of semi-automated quantification of collagen proportionate area (CPA) as an objective new method for predicting clinical outcomes.
Liver biopsies from patients with NAFLD underwent computerized image morphometry of Sirius Red staining with CPA quantification performed by ImageScope. Clinical outcomes, including total mortality, LRD, and combined liver outcomes (liver decompensation, HCC, or LRD), were determined by medical records and population-based data-linkage. The accuracy of CPA for predicting outcomes was compared with non-invasive fibrosis tests (Hepascore, FIB-4, APRI).
A total of 295 patients (mean age 50 years) were followed for a median (range) of 9 (0.2-25) years totalling 3253 person-years. Patients with CPA ≥ 10% had significantly higher risks for total death [hazard ratio (HR): 5.0 (1.9-13.2)], LRD [19.0 (2.0-182.0)], and combined liver outcomes [15.6 (3.1-78.6)]. CPA and pathologist fibrosis staging (FS) showed similar accuracy (AUROC) for the prediction of total death (0.68 vs. 0.70), LRD (0.72 vs. 0.77) and combined liver outcomes (0.75 vs. 0.78). Non-invasive serum markers Hepascore, APRI, and FIB-4 reached higher AUROC; however, they were not statistically significant compared to that of CPA except for Hepascore in predicting total mortality (0.86 vs. 0.68, p = 0.009).
Liver fibrosis quantified by CPA analysis was significantly associated with clinical outcomes including total mortality, LRD, and HCC. CPA achieved similar accuracy in predicting outcomes compared to pathologist fibrosis staging and non-invasive serum markers.
肝纤维化可预测非酒精性脂肪性肝病（NAFLD）患者的不良临床结局，如与肝脏相关的死亡（LRD）和肝细胞癌（HCC）。本研究旨在探讨胶原比例面积（CPA）半自动定量作为一种预测临床结局的新的客观方法的准确性。
对 NAFLD 患者的肝组织活检标本进行天狼星红染色的计算机图像形态计量学分析，并使用 ImageScope 进行 CPA 定量。通过病历和基于人群的数据链接确定临床结局，包括总死亡率、LRD 和联合肝脏结局（肝失代偿、HCC 或 LRD）。CPA 预测结局的准确性与非侵入性纤维化检测（Hepascore、FIB-4、APRI）进行比较。
共纳入 295 例（平均年龄 50 岁）患者，中位（范围）随访时间为 9（0.2-25）年，共随访 3253 人年。CPA≥10%的患者总死亡[风险比（HR）：5.0（1.9-13.2）]、LRD[19.0（2.0-182.0）]和联合肝脏结局[15.6（3.1-78.6）]的风险显著更高。CPA 和病理纤维化分期（FS）在预测总死亡（AUROC：0.68 比 0.70）、LRD（0.72 比 0.77）和联合肝脏结局（0.75 比 0.78）方面具有相似的准确性。非侵入性血清标志物 Hepascore、APRI 和 FIB-4 的 AUROC 更高；然而，除了 Hepascore 在预测总死亡率方面（0.86 比 0.68，p=0.009），与 CPA 相比，它们并不具有统计学显著差异。
CPA 分析定量的肝纤维化与包括总死亡率、LRD 和 HCC 在内的临床结局显著相关。CPA 在预测结局方面与病理纤维化分期和非侵入性血清标志物具有相似的准确性。
