The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury.

2.50
Hdl Handle:
http://hdl.handle.net/2336/226411
Title:
The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury.
Authors:
Suzuki, Ayako; Brunt, Elizabeth M; Kleiner, David E; Miquel, Rosa; Smyrk, Thomas C; Andrade, Raul J; Lucena, M Isabel; Castiella, Agustin; Lindor, Keith; Björnsson, Einar
Citation:
Hepatology 2011, 54(3):931-9
Issue Date:
2-Sep-2011
Abstract:
Distinguishing drug-induced liver injury (DILI) from idiopathic autoimmune hepatitis (AIH) can be challenging. We performed a standardized histologic evaluation to explore potential hallmarks to differentiate AIH versus DILI. Biopsies from patients with clinically well-characterized DILI [n = 35, including 19 hepatocellular injury (HC) and 16 cholestatic/mixed injury (CS)] and AIH (n = 28) were evaluated for Ishak scores, prominent inflammatory cell types in portal and intra-acinar areas, the presence or absence of emperipolesis, rosette formation, and cholestasis in a blinded fashion by four experienced hepatopathologists. Histologic diagnosis was concordant with clinical diagnosis in 65% of cases; but agreement on final diagnosis among the four pathologists was complete in only 46% of cases. Interface hepatitis, focal necrosis, and portal inflammation were present in all evaluated cases, but were more severe in AIH (P < 0.05) than DILI (HC). Portal and intra-acinar plasma cells, rosette formation, and emperiopolesis were features that favored AIH (P < 0.02). A model combining portal inflammation, portal plasma cells, intra-acinar lymphocytes and eosinophils, rosette formation, and canalicular cholestasis yielded an area under the receiver operating characteristic curve (AUROC) of 0.90 in predicting DILI (HC) versus AIH. All Ishak inflammation scores were more severe in AIH than DILI (CS) (P ≤ 0.05). The four AIH-favoring features listed above were consistently more prevalent in AIH, whereas portal neutrophils and intracellular (hepatocellular) cholestasis were more prevalent in DILI (CS) (P < 0.02). The combination of portal inflammation, fibrosis, portal neutrophils and plasma cells, and intracellular (hepatocellular) cholestasis yielded an AUC of 0.91 in predicting DILI (CS) versus AIH. Conclusion: Although an overlap of histologic findings exists for AIH and DILI, sufficient differences exist so that pathologists can use the pattern of injury to suggest the correct diagnosis.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.
Additional Links:
http://dx.doi.org/10.1002/hep.24481
Rights:
Archived with thanks to Hepatology (Baltimore, Md.)

Full metadata record

DC FieldValue Language
dc.contributor.authorSuzuki, Ayakoen_GB
dc.contributor.authorBrunt, Elizabeth Men_GB
dc.contributor.authorKleiner, David Een_GB
dc.contributor.authorMiquel, Rosaen_GB
dc.contributor.authorSmyrk, Thomas Cen_GB
dc.contributor.authorAndrade, Raul Jen_GB
dc.contributor.authorLucena, M Isabelen_GB
dc.contributor.authorCastiella, Agustinen_GB
dc.contributor.authorLindor, Keithen_GB
dc.contributor.authorBjörnsson, Einaren_GB
dc.date.accessioned2012-05-29T13:29:42Z-
dc.date.available2012-05-29T13:29:42Z-
dc.date.issued2011-09-02-
dc.date.submitted2012-05-29-
dc.identifier.citationHepatology 2011, 54(3):931-9en_GB
dc.identifier.issn1527-3350-
dc.identifier.pmid21674554-
dc.identifier.doi10.1002/hep.24481-
dc.identifier.urihttp://hdl.handle.net/2336/226411-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractDistinguishing drug-induced liver injury (DILI) from idiopathic autoimmune hepatitis (AIH) can be challenging. We performed a standardized histologic evaluation to explore potential hallmarks to differentiate AIH versus DILI. Biopsies from patients with clinically well-characterized DILI [n = 35, including 19 hepatocellular injury (HC) and 16 cholestatic/mixed injury (CS)] and AIH (n = 28) were evaluated for Ishak scores, prominent inflammatory cell types in portal and intra-acinar areas, the presence or absence of emperipolesis, rosette formation, and cholestasis in a blinded fashion by four experienced hepatopathologists. Histologic diagnosis was concordant with clinical diagnosis in 65% of cases; but agreement on final diagnosis among the four pathologists was complete in only 46% of cases. Interface hepatitis, focal necrosis, and portal inflammation were present in all evaluated cases, but were more severe in AIH (P < 0.05) than DILI (HC). Portal and intra-acinar plasma cells, rosette formation, and emperiopolesis were features that favored AIH (P < 0.02). A model combining portal inflammation, portal plasma cells, intra-acinar lymphocytes and eosinophils, rosette formation, and canalicular cholestasis yielded an area under the receiver operating characteristic curve (AUROC) of 0.90 in predicting DILI (HC) versus AIH. All Ishak inflammation scores were more severe in AIH than DILI (CS) (P ≤ 0.05). The four AIH-favoring features listed above were consistently more prevalent in AIH, whereas portal neutrophils and intracellular (hepatocellular) cholestasis were more prevalent in DILI (CS) (P < 0.02). The combination of portal inflammation, fibrosis, portal neutrophils and plasma cells, and intracellular (hepatocellular) cholestasis yielded an AUC of 0.91 in predicting DILI (CS) versus AIH. Conclusion: Although an overlap of histologic findings exists for AIH and DILI, sufficient differences exist so that pathologists can use the pattern of injury to suggest the correct diagnosis.en_GB
dc.description.sponsorshipAgencia Espanola del Medicament Fondo de Investigacion Sanitaria PS 09/01384 National Iinstitues of Health, National Cancer Instituteen_GB
dc.language.isoenen
dc.publisherWileyen_GB
dc.relation.urlhttp://dx.doi.org/10.1002/hep.24481en_GB
dc.rightsArchived with thanks to Hepatology (Baltimore, Md.)en_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshBiopsyen_GB
dc.subject.meshDrug-Induced Liver Injuryen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHepatitis, Autoimmuneen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLiveren_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.titleThe use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury.en
dc.typeArticleen
dc.contributor.departmentDivision of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA. suzuk004@mc.duke.eduen_GB
dc.identifier.journalHepatology (Baltimore, Md.)en_GB

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