title: Comprehensive clinical assessment improves the accuracy of predicting cirrhosis in chronic hepatitis C.
abstract: BACKGROUND
  The diagnosis of cirrhosis in chronic hepatitis C (CHC) is important but difficult in those who are unable to undergo liver biopsy. Thus, the aims of the present study were to compare separately and in combination, clinical markers of liver disease, the discriminant score (DS) and serum hyaluronic acid (HA) for their ability to predict cirrhosis in CHC.
  
  
  METHODS
  Two groups of consecutive patients (groups 1 and 2) with CHC were analyzed. Clinical data and routine laboratory results at the time of liver biopsy were collected, and serum HA levels were assayed. A clinical examination score (CES) was constructed using the sum of clinical markers of liver disease in group 1 and was validated in group 2, the DS was calculated, and a serum HA score (HAS) was produced. Combination scores were constructed using the sum of the CES, DS and HAS. Histological analysis of liver biopsies was performed by hepatopathologists blinded to clinical results.
  
  
  RESULTS
  One hundred and fifty-one patients with CHC (group 1, n = 47; group 2, n = 104) including 27 with cirrhosis were assessed. Serum HA was more accurate than either CES or DS in the prediction of cirrhosis. The combination of CES, DS and HAS enabled the most accurate prediction of cirrhosis with a sensitivity and specificity of 78% and 93%, and a positive predictive value and negative predictive value of 75% and 94%, respectively.
  
  
  CONCLUSIONS
  A comprehensive clinical assessment utilizing clinical and laboratory data more accurately predicts the presence and absence of cirrhosis in CHC than individual markers.
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Commercial Road, Prahran, Victoria 3181, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bailey
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid