HISTOPATHOLOGICAL SCORING VERSUS CLINICO-LABIORATORY PROFILE IN CHRONIC LIVER DISEASE AND NEONATAL CHOLESTASIS SYNDROME CASES
V.Varshney*, R. Khanna**, S. Alam***, A. Malik****, R. Sherwani*****
Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh*, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh **, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh***, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh****, Department of Pathology, Jawaharlal Nehru Medical College, Aligarh*****
Aim: To study the relationship between histopathological findings and clinico-laboratory parameters in chronic liver disease (CLD) and neonatal cholestasis syndrome (NCS) cases.

Methodology:
Histopathological evaluation of all liver biopsy tissues of CLD and NCS cases was done by the consultant pathologist in a blinded manner and biopsies were graded (from 0 to 4) to measure the severity of inflammation and staged (from 0 to 4) to measure the degree of fibrosis. We have clubbed grades and stages 0 & 1 in grade/stage 1 and 2-4 in grade/stage II respectively. Clinical features (jaundice, fever, duration of symptoms, malnutrition, hepatomegaly, splenomegaly, ascites and vitamin deficiencies) and laboratory parameters (serum transaminases, total bilirubin, serum proteins and prothrombin time) were noted. An association of the clinical features and laboratory profile was measured with the histopathological grade and stage.

Observation: 22 of 35 CLD cases and 12 of 23 NCS underwent liver biopsy. Histopathological grades I in 9 and II in 13 CLD cases; grade I & II in 6 NCS cases each. Histopathological stages I in 7 and II in 15 CLD cases; Stages I in 9 and II in 3 NCS cases. Presence of jaundice (1 out of 9 in grade I vs 10 out of 13 in grade II; p = 0.002) and higher bilirubin levels (1.6 + 1.3 mg/dL in grade I vs 4.9 + 4.5 mg/dL in grade II; p = 0.043) in the CLD group; absence of hepatomegaly (0 out of 6 in grade I vs 3 out of 6 in grade II; p = 0.046) in the NCS group showed significant association with the severe histopathological grades. While severe histological stage showed significant association with presence of fever (3 out of 7 in stage I vs 13 out of 15 in stage II; p = 0.032) and higher serum bilirubin (1.2 + 0.9 mg/dL in stage I vs 4.7 + 4.3 mg/dL in stage II; p = 0.045) in the CLD group; presence of vitamin-D deficiency (0 out of 9 in stage I vs 2 out 3 in stage II; p = 0.007), malnutrition (3 out of 9 in stage I vs 3 out of 3 in stage II; p = 0.046) and ascites (0 out of 9 in stage I vs 2 out 3 in stage II; p = 0.007) in the NCS group.

Conclusion: Fever, jaundice and raised bilirubin levels in the CLD group, while malnutrition, ascites, vitamin-D deficiency and shrunken liver in NCS group are associated with more severe inflammation and/or fibrotic activity in the liver tissue.
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