Spectrum of Liver Pathology in an Irish Coroner's Autopsy Population A Retrospective Study
S N Kalimuthu, M Bellis, MA Bolster, F O'Connell, TJ Browne. Cork University Hospital, Cork, Ireland; University of Toronto, Toronto, Canada
Background: Fatty liver disease, both alcoholic and non alcoholic is an increasing public health issue. Ireland has one of the highest rates of alcohol consumption world wide.The aim of this study was to evaluate the spectrum of liver histopathology findings in an Irish medicolegal autopsy population and to determine if fatty liver disease was a risk factor for accidental or other unnatural cause of death.
Design: All medicolegal (Coroners) autopsies in Cork and Kerry region (population approx 500,000) for a period of one year were evaluated for liver histopathology (Total 702 cases). The following parameters were assessed and graded according to standard histologic criteria; steatosis, steatohepatitis, fibrosis, hepatitis, other. All autopsy reports were reviewed for demographic details, cause of death and toxicology results. The causes of death were grouped into natural and accidental/ other unnatural causes. Unnatural causes included drowning, fire, hanging, road traffic accidents and falls.
Results: Histologic sections from 702 consecutive autopsies were reviewed. 488 males, 214 females (ratio 2.5:1), age range 3 weeks to 92 years (mean age 46years). Breakdown by cause of death was natural 517; unnatural 185. Mean age for natural and unnatural deaths was 63years and 45years respectively. Of the total cases (n=702), 336 (48%) showed evidence of steatosis,122 were graded as moderate or severe.162/702 (23%) had fibrosis, 7.3% had pericellular fibrosis and 4.5% had cirrhosis. Of the patients with steatosis (336), 21(6%) had coexisting cirrhosis, 36(10%) had coexisting pericellular fibrosis and 60 (18%) had coexisting steatohepatitis. Other pathologic findings included hepatitis 10/702 (1.4%), granulomas 5/702 (0.7%) and metastatic carcinoma 3/702 (0.4%). Of 185 unnatural deaths, 80 (43%) had histologic evidence of steatosis with 18% having blood alcohol levels in excess of 80mg%. In the natural group 50% had steatosis.
Conclusions: Liver pathology is a common finding in the medicolegal autopsy service in Ireland. Fatty liver disease with or without associated fibrosis is the dominant histologic pattern in this population. This spectrum is found in equal percentages in both the natural and unnatural cause of death groups. However, the age adjusted prevalence of fatty liver disease is higher in unnatural deaths which raises the question of a possible association between unnatural cause of death and fatty liver disease.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 11, Wednesday Afternoon