Number of portal tract macrophages correlates with the modified hepatic activity index in chronic hepatitis C infection

Ann Diagn Pathol. 2011 Apr;15(2):103-7. doi: 10.1016/j.anndiagpath.2010.11.003. Epub 2011 Jan 15.


The Ishak modified hepatic activity index (mHAI) is widely used to score disease activity in chronic hepatitis C infection. However, the scoring of the mHAI components is subjective and prone to interobserver variation. Liver injury results in increased numbers of portal tract macrophages, which are easily identified via periodic acid-Schiff with diastase digestion stain. Evaluation of 30 liver biopsies from patients with chronic hepatitis C revealed increasing numbers of portal tract macrophages as scores of liver inflammation increased. Specifically, the number of PASD-positive portal tract macrophages per centimeter of biopsy length correlated with the level of portal inflammation and total mHAI score, and these correlations were statistically significant (P = .039 and .029, respectively). Although the portal macrophage count appeared to correlate with the interface activity and lobular necroinflammatory score, this did not meet statistical significance (P = .073 and .079, respectively). Interobserver agreement by κ analysis was greater for the portal macrophage count than for any individual component of the mHAI score. In summary, the number of periportal ceroid-laden macrophages correlates with liver inflammation as measured using the mHAI, with better interobserver agreement. This technique may serve as a useful adjunct to the mHAI in the assessment of liver injury in hepatitis C.

MeSH terms

  • Biopsy
  • Hepatitis C, Chronic / pathology*
  • Humans
  • Inflammation / pathology
  • Liver / pathology*
  • Macrophages / pathology*
  • Observer Variation
  • Portal System / pathology*
  • Severity of Illness Index