Congestive Hepatic Fibrosis Score of Dai et al in a Patient with Right Heart Failure

Description

Dai et al reported the Congestive Hepatic Fibrosis Score, which is a grading system for the severity of histologic fibrosis in a patient with passive hepatic congestion. This correlates with right atrial pressure. The authors are from the University of Washington in Seattle.

Patient selection: chronic right heart failure with passive hepatic congestion

Evolution: congestion to centrizonal necrosis to hepatic fibrosis to cirrhosis (cardiac sclerosis)

Evaluation: liver biopsy stained with trichrome and reticulin stains

Centrizonal Fibrosis	Portal Fibrosis	Cirrhosis	Score
absent	absent	absent	0
present	absent	absent	1
present	mild	absent	2A
present	moderate, no bridging	absent	2B
present	with bridging	absent	3
present	with bridging	present	4

where:

• Initial bridging in congestive hepatic fibrosis is centrizonal to porta.

• Cirrhosis requires regenerative nodules.

A patient with congestive hepatic fibrosis may also show sinusoidal dilatation.

Fibrosis Score	Right Atrial Pressure
normal	5 mm Hg
0	9 mm Hg
1	13 mm Hg
2A	17 mm Hg
2B or 3	20 mm Hg

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Description

Specialty

ICD-10