Histological evaluation of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome: Correlation with Drum Tower Severity Scoring

Ruiqi Li; Lin Li; Zihao Cai; Jun Chen; Han Zhang; Si Zhao; Jingjing Tu; Chang Sun; Yani Jin; Ming Zhang; Feng Zhang; Wei Zhang; Qin Yin; Hui Xu; Hao Han; Taishun Li; Yuzheng Zhuge; Jiangqiang Xiao

doi:10.1016/j.dld.2023.12.008

Histological evaluation of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome: Correlation with Drum Tower Severity Scoring

Dig Liver Dis. 2023 Dec 26:S1590-8658(23)01096-4. doi: 10.1016/j.dld.2023.12.008. Online ahead of print.

Authors

Ruiqi Li¹, Lin Li², Zihao Cai³, Jun Chen², Han Zhang³, Si Zhao³, Jingjing Tu³, Chang Sun³, Yani Jin³, Ming Zhang³, Feng Zhang³, Wei Zhang³, Qin Yin³, Hui Xu³, Hao Han⁴, Taishun Li⁵, Yuzheng Zhuge⁶, Jiangqiang Xiao⁷

Affiliations

¹ Department of Gastroenterology, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China; School of Medicine, Southeast University, Nanjing, China.
² Department of Pathology, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China.
³ Department of Gastroenterology, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China.
⁴ Department of Ultrasound, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China.
⁵ Medical Statistical Analysis Center, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China.
⁶ Department of Gastroenterology, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China; School of Medicine, Southeast University, Nanjing, China. Electronic address: yuzheng9111963@aliyun.com.
⁷ Department of Gastroenterology, Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, China. Electronic address: Xiaojiangqiang@drumtowerhep.group.

PMID: 38151450
DOI: 10.1016/j.dld.2023.12.008

Abstract

Background: Hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids (PA-HSOS) is a complication of drug-induced liver damage. Few studies have examined the relationship between pathological changes and clinical circumstances in PA-HSOS. The Drum Tower Severity Scoring System (DTSS) was developed using prognostic indicators from clinical treatment outcomes. We hypothesized that the severity of pathological damage is consistent with DTSS.

Aims: We aimed to improve our understanding and assessment of vascular liver injury disease histopathology by studying larger sample sizes of human histopathological samples. We also wanted to confirm the link between histopathological findings and DTSS.

Methods: The study included 62 patients with PA-HSOS who underwent transjugular liver biopsy. Their hepatic pathological tissues were evaluated. Analyses of linear regression and Spearman's correlation were employed to examine the relationship between DTSS and pathological characteristics.

Results: Clinical performance and the DTSS score were used to determine histopathological severity. The sinusoidal congestion area (SCA), central venous endothelial injury (CVEI), and fibrinoid exudation in congestion foci (FECF) were significant indicators. SCA was linearly related to the DTSS score.

Conclusion: Our findings show that hepatic pathological characteristics correlate with DTSS scores in PA-HSOS. SCA, CVEI, and FECF may be helpful for determining PA-HSOS severity.

Keywords: Acute portal hypertension; Pathology.