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Validation of a Congestive Hepatic Fibrosis Scoring System

Bosch, Dustin E. MD, PhD*; Koro, Konstantin MD*; Richards, Elizabeth MD*; Hoch, Benjamin L. MD*; Jalikis, Florencia MD*; Koch, Lisa K. MD, PhD*; Swanson, Paul E. MD*; Truong, Camtu D. MD*; Liou, Iris MD; Yu, Lei MD; Bhattacharya, Renuka MD; Yeh, Matthew M. MD, PhD*,†

The American Journal of Surgical Pathology: June 2019 - Volume 43 - Issue 6 - p 766–772
doi: 10.1097/PAS.0000000000001250
Original Articles

Congestive hepatopathy is a complication of right heart failure and chronically elevated right heart pressure. Histologic findings include sinusoidal dilatation, centrilobular hepatocellular plate atrophy, and fibrosis. We performed a validation study of a recently proposed scoring system (0 to 4 scale) for congestive hepatic fibrosis on 38 liver biopsies. Glutamine synthetase immunohistochemistry was also performed, and loss of centrizonal immunoreactivity correlated with increasing fibrosis score (P<0.01). Interobserver concordance for congestive hepatic fibrosis score based on Masson trichrome stain was initially fair (Fleiss κ=0.28, weighted concordance coefficient=0.60) and significantly improved (κ=0.40, weighted concordance coefficient=0.66) following a multiheaded microscope training session and inclusion of glutamine synthetase immunohistochemistry. Average congestive hepatic fibrosis score correlated with significantly higher right atrial pressure, severity of right atrial dilation, presence of right ventricular dilation, elevated serum alanine aminotransferase, platelet counts, prothrombin time, and model for end-stage liver disease score. In conclusion, the congestive hepatic fibrosis scoring system is reproducible among pathologists and correlates with clinical and laboratory markers of congestive hepatopathy.

Departments of *Pathology

Medicine, University of Washington, Seattle, WA

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Matthew M. Yeh, MD, PhD, Department of Pathology, University of Washington School of Medicine, 1959 NE Pacific Street, NE140D, P.O. Box 356100, Seattle, WA 98195 (e-mail:

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