Histological determinants of increased liver stiffness in alcoholic liver disease

Background: Transient elastography (Fibroscan) is a rapidly expanding noninvasive technique to assess liver fibrosis. Besides matrix deposition, several other factors such as inflammation or hepatic congestion are known to affect liver stiffness (LS). Thus far, histological determinants of liver stiffness are poorly understood.

Method: LS was measured in 103 patients with histologically confirmed alcoholic liver disease. Liver fibrosis was assessed by two histological scores (Kleiner versus semiquantitative Chevallier score). In addition, collagen stain was quantified using a morphometric computer assisted analysis of collagen stain (Sirius red). LS was further correlated with histological subscores for steatosis, inflammation and other ALD features.

Results: The semiquantitative Chevallier (0.800, all P<0.001) correlated higher with LS than the Kleiner score (0.719). Both histological scores correlated better as compared to morphometry. Interestingly, within the Chevallier subscoring system, number and width of septa alone were highly correlated with LS (0.772 and 0.706). Classical features such as Mallory's hyaline (0.367), ballooning (0.347) and lobular inflammation (0.248) also correlated well with LS. In contrast, steatosis, portal inflammation, number of megamitochondria and glycogenated nuclei were not related to LS.

Conclusion: Histological subanalysis indicates that, besides collagen deposition, morphological indications for volume increase as lobular inflammation and ballooning are important determinants of LS.