Evaluating the accuracy of the histological diagnosis in unexplained liver injury: A retrospective study

Liver biopsy is a valuable tool for diagnosing liver diseases with unknown etiology, but it sometimes fails to provide a clear diagnosis. This study aimed to identify the cause of unexplained liver injury and evaluate the accuracy of histological diagnosis.

A retrospective analysis was conducted on the clinical and histological data of patients with chronic liver disease of unknown etiology at the Second Affiliated Hospital of Nanchang University, China, who underwent liver biopsy between September 2019 and June 2024. Diagnoses were divided into admission diagnosis, histological diagnosis, and final clinical diagnosis groups.

A total of 104 patients were included, with 64 women (61.5 %) and 40 men (38.5 %), 96 (92.3 %) of whom received a definitive diagnosis through liver biopsy. The main diseases were autoimmune liver disease (AILD, 49 cases, 47.1 %), non-alcoholic fatty liver disease (NAFLD, 26 cases, 25.0 %), drug-induced liver injury (DILI, 22 cases, 21.2 %), others (11 cases, 10.6 %) and unknown etiology (8 cases, 6.9 %). AILD was most common in women (40 cases, 55.6 %), while NAFLD was most common in men (19 cases, 40.4 %). Histological diagnosis showed higher sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) compared to admission diagnosis. Venn diagram analysis revealed that 57.7 % of cases matched between admission and histological diagnosis, 60.6 % matched between admission and final clinical diagnosis, and 92.3 % matched between the histological and final clinical diagnosis.

Histological diagnosis is effective in determining the cause of unexplained liver injury, and liver biopsy remains a crucial tool.