Chronic hepatitis: Disease factors at diagnosis predictive of mortality

Lashner, Bret A.; Jonas, Richard B.; Tang, Haoning; Evans, Alison A.; Ozeran, Steven; Baker, Alfred L.

doi:10.1016/s0002-9343(88)80230-4

Cited by 31 publications

(4 citation statements)

References 23 publications

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“…A further 16 articles [13,22,24,45-57] were found through hand searching bibliographic references. Twelve articles [37,38,40,41,44-47,49,51,53,57] met inclusion criteria. Of the 17 studies excluded, eight studies did not report data for physical signs, two enrolled only cirrhotic patients, five studies did not include sufficient data to calculate summary measures of diagnostic accuracy, and one was a review article.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies mainly enrolled patients with chronic viral hepatitis [38,40,44], four mainly with alcohol- related liver disease [37,49,51,53], and one with predominantly autoimmune hepatitis [47]. The remainder reported a presumed etiology for less than 50% of the study population.…”

Section: Resultsmentioning

confidence: 99%

“…In two studies [38,49], it was not clear whether the decision to perform the biopsy was taken independently of clinical data. Five studies reported on exclusions [37,38,40,53,57]. These ranged from 12.7% (44 of 347) to 39.3% (22 of 56).…”

Section: Resultsmentioning

confidence: 99%

“…Numbers refer to studies: 1 = Schenker [53], 2 = Czaja [46], 3 = Cozzolino [45], 4 = Hay CRM [38], 5= Lashner [40], 6 = Hay JE [47], 7 = Tinè [57], 8 = Marmo [41], 9 = Nakamura [49], 10 = Rankin [51]. Light gray box depicts point estimate (cross) with 95% confidence limits for random effects model estimates of sensitivity and specificity.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis

Bruyn

Graviss

2001

BMC Med Inform Decis Mak

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BackgroundWe conducted a review of the diagnostic accuracy of clinical examination for the diagnosis of cirrhosis. The objectives were: to identify studies assessing the accuracy of clinical examination in the detection of cirrhosis; to summarize the diagnostic accuracy of reported physical examination findings; and to define the effects of study characteristics on estimates of diagnostic accuracy.MethodsStudies were identified through electronic literature search of MEDLINE (1966 to 2000), search of bibliographic references, and contact with authors. Studies that evaluated indicants from physical examination of patients with known or suspected liver disease undergoing liver biopsy were included. Qualitative data on study characteristics were extracted. Two-by-two tables of presence or absence of physical findings for patients with and without cirrhosis were created from study data. Data for physical findings reported in each study were combined using Summary Receiver Operating Characteristic (SROC) curves or random effects modeling, as appropriate.ResultsTwelve studies met inclusion criteria, including a total of 1895 patients, ranging in age from 3 to 90 years. Most studies were conducted in referral populations with elevated aminotransferase levels. Ten physical signs were reported in three or more studies and ten signs in only a single study. Signs for which there was more study data were associated with high specificity (range 75–98%), but low sensitivity (range 15–68%) for histologically-proven cirrhosis.ConclusionsPhysical findings are generally of low sensitivity for the diagnosis of cirrhosis, and signs with higher specificity represent decompensated disease. Most studies have been undertaken in highly selected populations.

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