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Review
. 2010 Apr;51(4):1445-9.
doi: 10.1002/hep.23478.

Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis

Guadalupe Garcia-Tsao  1 , Scott Friedman, John Iredale, Massimo Pinzani
Affiliations
Review

Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis

Guadalupe Garcia-Tsao et al. Hepatology. 2010 Apr.
No abstract available

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Figures

Fig. 1
Fig. 1
Classification of chronic liver disease based on histological, clinical, hemodynamic, and biological parameters. In the noncirrhotic stage (METAVIR F1–F3), there is no clinical evidence of cirrhosis, the HVPG is below 6 mmHg, and at this stage there is fibrogenesis and neovascularization. The cirrhotic stage (METAVIR F4) is broadly classified into two stages: compensated and decompensated, with clinical decompensation being defined by the development of ascites, variceal hemorrhage (VH), encephalopathy, and jaundice. Within the compensated stage, patients can be subclassified into those without varices (stage 1) and those with varices (stage 2). Those without varices can be further subclassified into those with an hepatic venous pressure gradient (HVPG) < or > 10 mmHg, which is the threshold pressure that predicts development of varices and decompensation. HVPG > 10 mmHg (clinically significant portal hypertension) correlates with thick scar and small nodules. In the decompensated stage, the scar is resistant to degradation. Complex circulatory (splanchnic and systemic) abnormalities that occur at this decompensated stage contribute to further decompensation, i.e., recurrent variceal hemorrhage, refractory ascites, and hepatorenal syndrome, and although HVPG retains prognostic value, other parameters that take into account liver insufficiency and a deranged circulatory state, such as the MELD score, are more predictive of death (not depicted in figure). Figure is modified from Friedman.
See this image and copyright information in PMC

Comment in

  • Histological subclassification of cirrhosis.
    Germani G, Dhillon A, Andreana L, Calvaruso V, Manousou P, Isgró G, Burroughs AK. Germani G, et al. Hepatology. 2010 Aug;52(2):804-5. doi: 10.1002/hep.23655. Hepatology. 2010. PMID: 20593457 No abstract available.

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