Quantification of fibrosis by collagen proportionate area predicts hepatic decompensation in hepatitis C cirrhosis

BackgroundIt is unclear whether the course of cirrhosis and its prognosis are related tothe amount of collagen in the liver.AimTo determine whether fibrosis, assessed by collagen proportionate area(CPA) in patients with compensated cirrhosis, is associated with the presenceof oesophageal varices, and predict disease decompensation during thefollow-up period.MethodsWe prospectively evaluated 118 consecutive patients with compensated cirrhosisto correlate fibrosis, assessed by CPA in liver biopsies, with the presenceof oesophageal varices (OV) and with the rate of liver decompensation(LD) development during a median follow-up of 72 months.ResultsAt baseline 38 (32.2%) patients had OV and during the follow-up (median72 months, IQR 47–91), 17 patients (14.4%) developed LD. The mean CPAvalue was different in patients with and without OV (14.8 5.9% vs.21.6 9.5%, P < 0.001). The best CPA cut-off for OV by area under thereceiver operating characteristic (AUROC) was ≥14% and with multivariatelogistic analysis CPA was the only variable associated with OV (OR: 28.32,95% CI: 6.30–127.28; P < 0.001). By AUROC analysis the best CPA cut-offto predict LD was 18.0%. By Cox regression multivariate analysis CPA≥18% (HR: 3.99, 95% CI: 1.04–11.45; P = 0.036), albumin (HR: 0.12, 95%CI: 0.04–0.43; P = 0.001) and presence of OV (HR: 8.15, 95% CI: 2.31–28.78; P = 0.001) were independently associated with LD.ConclusionQuantification of fibrosis by collagen proportionate area allows identificationof patients with compensated HCV cirrhosis with a higher likelihood ofclinically relevant portal hypertension and a higher risk of decompensation.