Prediction of histopathological grades of liver pathology in cholestasis by direct bilirubin, aspartate aminotransferase, alanine aminotransferase and albumin level

Abstract

Background: Liver biopsy, a routine diagnostic procedure in Dr. Soetomo General Hospital Surabaya, is a valuable tool in the diagnosis, prognosis, and management of parenchymal liver disease. However, the correlation between histopathological features and direct bilirubin, aspartate transaminase (AST), alanine transaminase (ALT) and albumin level has not yet been established. Objectives: To correlate various histopathological features with direct bilirubin, AST, ALT and albumin level of children with cholestasis. Method: This is a retrospective study of 51 cases of cholestasis diagnosed and treated from January 2011 to December 2016. All biopsies were reviewed and graded by a semi-quantitative scoring system according to Muthukanagarajan et al and categorized into fibrosis, bile duct proliferation, cholestasis and duct plate malformation. Degrees of all features were compared with direct bilirubin, AST, ALT, and albumin level. Statistical analysis used one way ANOVA, Kruskal-Wallis and unpaired t-test. p<0.05 was considered significant. Results: There were 30 males and 21 females with a median age of 3 (1-9) months and a mean weight of 5 (1.41) kg. Degree of fibrosis was negative (47%), mild (22%), moderate (31%) and severe (0%). Bile duct proliferation was negative (57%), mild (21%), moderate (14%) and severe (8%). Cholestasis was negative in 0%, mild in 14%, moderate in 69% and severe in 18%; duct plate malformation was negative in 63% and positive in 37%. Direct bilirubin level showed significant difference with degree of duct proliferation (p=0.024). There was no significant difference of AST level with all degrees of histopathological grade. ALT level showed significant difference with degree of fibrosis (p=0.043). Albumin level showed significant difference with degree of fibrosis (p=0.000), degree of duct proliferation (p=0.006) and duct plate malformation (p=0.037). Conclusions: This study showed that while the direct bilirubin level was significantly associated with the degree of duct proliferation and the ALT level was significantly associated with the degree of fibrosis, the albumin level was significantly associated with the degree of fibrosis, degree of duct proliferation and degree of duct plate malformation.