The prognostic significance of bridging hepatic necrosis in chronic type B hepatitis: a histopathologic study

A histopathologic follow-up study was conducted in 207 consecutive patients to examine the prognostic significance of bridging hepatic necrosis (BHN) in chronic type B hepatitis. One hundred and eight patients showed BHN and the other 99 intralobular spotty necrosis (SN) on initial biopsy. A higher proportion of patients with BHN healed (45.4% vs 26.4%) or developed cirrhosis (18.3% vs 3%) than the patients with SN. In contrast, intralobular inflammation persisted or recurred more frequently in the SN than in the BHN group (40.4% vs 5.6%). These figures were statistically significant (P less than 0.001). Alternatively, 87% of the patients who developed cirrhosis had had BHN as their initial histologic presentations. The estimated relative risk of cirrhotic progression for the BHN group compared to the SN group was 4:1. We conclude that BHN is a paradoxical prognostic factor, either for healing, or cirrhotic progression.