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Clinical and prognostic value of quantified fibrosis in alcoholic liver cirrhosis



Clinical and prognostic value of quantified fibrosis in alcoholic liver cirrhosis



Revista Espanola de las Enfermedades del Aparato Digestivo 68(5): 413-419



In order to study its clinical and prognostic value, the surface of fibrous septa present in the liver biopsy of 129 patients with alcoholic cirrhosis (99 male and 30 female, average age 52,47 .+-. 1) was measured with a semiautomatic image analyzer LEITZ ASM. The degree of fibrosis was related (100 .times. fibrosis/parenchymas + fibrosis) to several clinical and biologic parameters and the patients were classified in three groups (I, II, III, the last meaning the highest degree of decompensation) according to the results. The degree of fibrosis was much greater in the patients of group III (39.68 .+-. 2.1) than in those of group II (30.2 .+-. 2.16) (t = 4.3; p < 0.001) and group I (25.77 .+-. 2.27) (t = 6.53; p < 0.001). We found a statistically significant correlation between prothrombin activity and fibrosis in all 129 patients (r = 0.44; p < 0.001) and between fibrosis and gammaglobulin (r = 0.18; p < 0.005). Eighty-five out of the 129 patients were followed-up during 619.1 .+-. 533.7 days. Thirty of them died, 26 with liver failure: ten died before 250 days, 18 before 500 days, 20 before 750 days and 22 before 1.000 days since the biopsy was done. The differences between the degree of fibrosis of those patients who liver over 250, 500, 750 and 1.000 days and those who died before these delays were compared among them and to the differences of prothrombin activity, albumin levels, gammaglobulin and bilirubin in the above mentioned 4 pairs of patient groups. Fibrosis was greater in patients dying before 250 days (t = 2.2; p < 0.05), 500 days (t = 3.23; p < 0.005), 750 days (t = 2.45; p < 0.02) and 1000 days (t = 3.17; p < 0.005) than in those that survived these periods of time. The differences obtained for fibrosis were slightly higher than those obtained for prothrombin activity and much higher than those obtained for albumin, gammaglobulin and bilirubin. We therefore conclude that the degree of fibrosis is much greater in decompensated patients and that qualification of fibrosis has a certain prognostic value with respect to the survival of the cirrhotic patient at short and mean delay, slightly higher than that of prothrombin and clearly superior to that of bilirubin, albumin and gammaglobulin.

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