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Context: Among adult patients with liver disease, the ability to identify those most likely to have cirrhosis noninvasively is challenging.
Objective: To identify simple clinical indicators that can exclude or detect cirrhosis in adults with known or suspected liver disease.
Data Sources: We searched MEDLINE and EMBASE (1966 to December 2011) and reference lists from retrieved articles, previous reviews, and physical examination textbooks.
Study Selection: We retained 86 studies of adequate quality that evaluated the accuracy of clinical findings for identifying histologically proven cirrhosis.
Data Extraction: Two authors independently abstracted data (sensitivity, specificity, and likelihood ratios [LRs]) and assessed methodological quality. Random-effects meta-analyses were used to calculate summary LRs across studies.
Results: Among the 86 studies, 19,533 patients were included in this meta-analysis, among whom 4725 had biopsy-proven cirrhosis (prevalence rate, 24%; 95% CI, 20%-28%). Many physical examination and simple laboratory tests increase the likelihood of cirrhosis, though the presence of ascites (LR, 7.2; 95% CI, 2.9-12), a platelet count <160 x 10(3)/μL (LR, 6.3; 95% CI, 4.3-8.3), spider nevi (LR, 4.3; 95% CI 2.4-6.2), or a combination of simple laboratory tests with the Bonacini cirrhosis discriminant score >7 (LR, 9.4; 95% CI, 2.6-37) are the most frequently studied, reliable, and informative results. For lowering the likelihood of cirrhosis, the most useful findings are a Lok index <0.2 (a score created from the platelet count, serum aspartate aminotransferase and alanine aminotransferase, and prothrombin international normalized ratio; LR, 0.09; 95% CI, 0.03-0.31); a platelet count ≥160 x 10(3)/μL (LR, 0.29; 95% CI, 0.20-0.39); or the absence of hepatomegaly (LR, 0.37; 95% CI, 0.24-0.51). The overall impression of the clinician was not as informative as the individual findings or laboratory combinations.
Conclusions: 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.
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http://dx.doi.org/10.1001/jama.2012.186 | DOI Listing |
Br J Haematol
March 2025
Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, Larissa, Greece.
This study examined mortality rates among 2475 patients with thalassaemia and sickle cell disease (SCD) per year over 12 years in Greece, recording 335 deaths (27.92/year), with an overall mortality rate of 1.13% per year.
View Article and Find Full Text PDFDig Liver Dis
March 2025
Punjab Medical College, Faisalabad Medical University, Pakistan. Electronic address:
Dig Liver Dis
March 2025
Department of Neurology, Shandong Provincial Hospital, Shandong University, Shandong, China. Electronic address:
Dig Liver Dis
March 2025
Endoscopy Unit, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Spain.
Background: Endoscopic forceps biopsy is the primary method for obtaining mucosal tissues, but can lead to false negatives.
Aims: To assess the agreement between endoscopic biopsies and submucosal dissection specimens in esophageal and gastric epithelial lesions and to identify factors associated.
Methods: Cross-sectional study using data from the Spanish national multicenter endoscopic submucosal dissection register.
Background And Aim: Alcohol-associated liver disease (ALD) and metabolic associated steatohepatitis (MASH) are leading indications for liver transplant (LT). Data are limited on their trends and association with candidate characteristics.
Methods And Results: UNOS database (2002-22) examined on proportion of ALD or of NASH etiology among LT listings comparing 2002-11 vs.
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