Does This Patient With Liver Disease Have Cirrhosis?

Abstract

For identifying cirrhosis, the presence of a variety of clinical findings or abnormalities in a combination of simple laboratory tests that reflect the underlying pathophysiology increase its likelihood. To exclude cirrhosis, combinations of normal laboratory findings are most useful.

Utility of Platelet Count for Predicting Cirrhosis in Alcoholic Liver Disease: Model for Identifying Cirrhosis in a US Population

“…This difference in diagnostic ability is due to the direct toxic effect of alcohol on the presobriety platelet count, which is no longer evident on the platelet count obtained after a minimum of 7 days of alcohol abstinence. As such, the platelet count obtained after a period of alcohol abstinence at a cutoff of 160*10 3 cells/mm 3 had a likelihood ratio similar to that of the platelet count in the study published by Udell et al 6 , suggesting that after a minimum 7 days of alcohol abstinence, the diagnostic utility of platelet count in alcoholic cirrhosis was similar to that in cirrhosis of viral etiology. However, it may not be possible to obtain a sobriety platelet count in all alcoholic patients.…”

“…A recent meta-analysis by Udell et al 6 identified thrombocytopenia as the single most important laboratory test for identifying cirrhosis of varying etiologies. The authors concluded that a platelet count cutoff of 160*10 3 has a positive LR of 6.3 and negative LR of 0.29 in predicting cirrhosis of varying etiologies.…”

“…Ultrasonography identifies cirrhosis with reasonable sensitivity and specificity 5 , but may not be feasible in every case. Studies have shown that thrombocytopenia is the single most useful laboratory predictor of cirrhosis with viral etiology 6 . In cirrhosis, thrombocytopenia occurs as a result of a combination of hypersplenism secondary to portal hypertension and impaired thrombopoiesis from inadequate hepatic cell generation of thrombopoietin.…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…Meta-analyses of studies were limited, and a search found two studies [83,84]. Poynard et al examined biomarkers of liver fibrosis, and his main objective was to examine the diagnostic utility of the biomarker for advanced fibrosis defined as CF2 (METAVIR system) based entirely on the AUROC curve [83].…”

“…Data were not pooled for many of the tests, and when comparisons were made, pooling was used; hence, there were many inconsistencies in the description of the results. Udell et al [84] examined routine markers to assess their clinical utility to determine the presence of cirrhosis, regardless of underlying disease, a somewhat different question from that of the Poynard's study. The performance characteristics of clinical examination, individual laboratory tests and combination indices or models were summarized in the paper as sensitivity, specificity and LR (positive and negative) ( Tables 9, 10).…”