The need for histological subclassification of cirrhosis: a systematic review and meta-analysis

Background & Aims: The need for further histological subclassification of cirrhosis has been increasingly recognized because of the heterogeneity of severity within cirrhosis. We sought to identify evidence in the literature regarding the histological subclassification of cirrhosis using the Laennec stage. Methods: We conducted a systematic review and meta-analysis by searching databases, including MEDLINE, EMBASE and the COCHRANE library, for relevant studies. Results: Of 208 studies identified, 16 were eligible according to the inclusion criteria. With higher grades of the Laennec stage, clinical stages of cirrhosis and Child-Pugh scores/Model for end-stage liver disease scores increased (P < 0.05). Higher Laennec stages were statistically associated with the development of liver-related events, such as liver-related death, liver cancer progression and variceal haemorrhage, as well as higher hepatic venous pressure gradients and higher liver stiffness values (P < 0.05). Two open-labelled studies showed the usefulness of the Laennec system with regard to the evaluation of whether antifibrotic treatments were effective. The mean kappa value was 0.81 (range 0.61-0.87) for inter-observer agreement. Conclusions: Based on this systematic review and meta-analysis, histological subclassification of cirrhosis using the Laennec system is useful to better predict prognosis and complications of portal hypertension.