Does This Patient With Liver Disease Have Cirrhosis?
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 searche...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2012-02, Vol.307 (8), p.832-842 |
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| creator | Udell, Jacob A Wang, Charlie S Tinmouth, Jill FitzGerald, J. Mark Ayas, Najib T Simel, David L Schulzer, Michael Mak, Edwin Yoshida, Eric M |
| description | 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 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 |
| doi_str_mv | 10.1001/jama.2012.186 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_923576178</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>1355997</ama_id><sourcerecordid>923576178</sourcerecordid><originalsourceid>FETCH-LOGICAL-a368t-11070e2a5ab995195f51a17ebf08089c4e4091a607991bbeefcce89db589e1483</originalsourceid><addsrcrecordid>eNpd0M9LwzAUB_AgipvToxcPUgTx1JnXNE1yEtnUCQM9TDyWtHtlGf0xk3bgf2_K5gTfJZcP37z3JeQS6Bgohfu1rvQ4ohCNQSZHZAicyZBxJY_JkFIlQxHLeEDOnFtTP8DEKRlEEeNCsnhI4mmDLlisjAvedWuwboNP066CudmiDabGoXYYzPQWg4mxdtU44x7OyUmhS4cX-3dEPp6fFpNZOH97eZ08zkPNEtmGAFRQjDTXmVIcFC84aBCYFVRSqfIYY6pAJ1QoBVmGWOQ5SrXMuFQIsWQjcrfL3djmq0PXppVxOZalrrHpXKr6MxIQvbz5J9dNZ2u_nEdSxEJI7lG4Q7ltnLNYpBtrKm2_U6BpX2bal5n2Zaa-TO-v96FdVuHyoH_b8-B2D7TLdVlYXefG_Tnut-MQeXe1c3384U_GuVKC_QC5MYJl</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>928747785</pqid></control><display><type>article</type><title>Does This Patient With Liver Disease Have Cirrhosis?</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Udell, Jacob A ; Wang, Charlie S ; Tinmouth, Jill ; FitzGerald, J. Mark ; Ayas, Najib T ; Simel, David L ; Schulzer, Michael ; Mak, Edwin ; Yoshida, Eric M</creator><creatorcontrib>Udell, Jacob A ; Wang, Charlie S ; Tinmouth, Jill ; FitzGerald, J. Mark ; Ayas, Najib T ; Simel, David L ; Schulzer, Michael ; Mak, Edwin ; Yoshida, Eric M</creatorcontrib><description>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 × 103/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 × 103/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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2012.186</identifier><identifier>PMID: 22357834</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Adults ; Alanine Transaminase - blood ; Ascites - etiology ; Aspartate Aminotransferases - blood ; Biological and medical sciences ; Biomarkers - blood ; Diabetes Mellitus ; Diagnosis, Differential ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Hemangioma - etiology ; Hepatitis C - complications ; Humans ; International Normalized Ratio ; Jaundice - etiology ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - etiology ; Liver Cirrhosis - physiopathology ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Meta-analysis ; Middle Aged ; Other diseases. Semiology ; Physical Examination ; Platelet Count ; Risk Factors ; Sensitivity and Specificity ; Systematic review</subject><ispartof>JAMA : the journal of the American Medical Association, 2012-02, Vol.307 (8), p.832-842</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Medical Association Feb 22-Feb 29, 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a368t-11070e2a5ab995195f51a17ebf08089c4e4091a607991bbeefcce89db589e1483</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2012.186$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2012.186$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3326,27903,27904,76235,76238</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25576512$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22357834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Udell, Jacob A</creatorcontrib><creatorcontrib>Wang, Charlie S</creatorcontrib><creatorcontrib>Tinmouth, Jill</creatorcontrib><creatorcontrib>FitzGerald, J. Mark</creatorcontrib><creatorcontrib>Ayas, Najib T</creatorcontrib><creatorcontrib>Simel, David L</creatorcontrib><creatorcontrib>Schulzer, Michael</creatorcontrib><creatorcontrib>Mak, Edwin</creatorcontrib><creatorcontrib>Yoshida, Eric M</creatorcontrib><title>Does This Patient With Liver Disease Have Cirrhosis?</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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 × 103/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 × 103/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.</description><subject>Adult</subject><subject>Adults</subject><subject>Alanine Transaminase - blood</subject><subject>Ascites - etiology</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Diabetes Mellitus</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Hemangioma - etiology</subject><subject>Hepatitis C - complications</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Jaundice - etiology</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - etiology</subject><subject>Liver Cirrhosis - physiopathology</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Physical Examination</subject><subject>Platelet Count</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Systematic review</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0M9LwzAUB_AgipvToxcPUgTx1JnXNE1yEtnUCQM9TDyWtHtlGf0xk3bgf2_K5gTfJZcP37z3JeQS6Bgohfu1rvQ4ohCNQSZHZAicyZBxJY_JkFIlQxHLeEDOnFtTP8DEKRlEEeNCsnhI4mmDLlisjAvedWuwboNP066CudmiDabGoXYYzPQWg4mxdtU44x7OyUmhS4cX-3dEPp6fFpNZOH97eZ08zkPNEtmGAFRQjDTXmVIcFC84aBCYFVRSqfIYY6pAJ1QoBVmGWOQ5SrXMuFQIsWQjcrfL3djmq0PXppVxOZalrrHpXKr6MxIQvbz5J9dNZ2u_nEdSxEJI7lG4Q7ltnLNYpBtrKm2_U6BpX2bal5n2Zaa-TO-v96FdVuHyoH_b8-B2D7TLdVlYXefG_Tnut-MQeXe1c3384U_GuVKC_QC5MYJl</recordid><startdate>20120222</startdate><enddate>20120222</enddate><creator>Udell, Jacob A</creator><creator>Wang, Charlie S</creator><creator>Tinmouth, Jill</creator><creator>FitzGerald, J. Mark</creator><creator>Ayas, Najib T</creator><creator>Simel, David L</creator><creator>Schulzer, Michael</creator><creator>Mak, Edwin</creator><creator>Yoshida, Eric M</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20120222</creationdate><title>Does This Patient With Liver Disease Have Cirrhosis?</title><author>Udell, Jacob A ; Wang, Charlie S ; Tinmouth, Jill ; FitzGerald, J. 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Abdomen</topic><topic>General aspects</topic><topic>Hemangioma - etiology</topic><topic>Hepatitis C - complications</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Jaundice - etiology</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - etiology</topic><topic>Liver Cirrhosis - physiopathology</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Physical Examination</topic><topic>Platelet Count</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Udell, Jacob A</creatorcontrib><creatorcontrib>Wang, Charlie S</creatorcontrib><creatorcontrib>Tinmouth, Jill</creatorcontrib><creatorcontrib>FitzGerald, J. 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Mark</au><au>Ayas, Najib T</au><au>Simel, David L</au><au>Schulzer, Michael</au><au>Mak, Edwin</au><au>Yoshida, Eric M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does This Patient With Liver Disease Have Cirrhosis?</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2012-02-22</date><risdate>2012</risdate><volume>307</volume><issue>8</issue><spage>832</spage><epage>842</epage><pages>832-842</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>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 × 103/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 × 103/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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>22357834</pmid><doi>10.1001/jama.2012.186</doi><tpages>11</tpages></addata></record> |
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| subjects | Adult Adults Alanine Transaminase - blood Ascites - etiology Aspartate Aminotransferases - blood Biological and medical sciences Biomarkers - blood Diabetes Mellitus Diagnosis, Differential Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Hemangioma - etiology Hepatitis C - complications Humans International Normalized Ratio Jaundice - etiology Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - etiology Liver Cirrhosis - physiopathology Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Meta-analysis Middle Aged Other diseases. Semiology Physical Examination Platelet Count Risk Factors Sensitivity and Specificity Systematic review |
| title | Does This Patient With Liver Disease Have Cirrhosis? |
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