A predictive index for the diagnosis of cirrhosis in hepatitis C based on clinical, laboratory, and ultrasound findings.
OBJECTIVE
To develop and validate a non-invasive index to predict the presence of cirrhosis in patients with chronic hepatitis C on the basis of clinical, laboratory, and ultrasound findings.


METHODS
Data from the complete history and physical examination, serologic studies, liver ultrasound, and liver biopsy of patients with chronic hepatitis C were analyzed using multivariate regression to develop a cirrhosis predictive index. This index was then applied prospectively to another group of patients with chronic hepatitis C to determine its accuracy.


RESULTS
Three hundred and thirty-two patients were included (mean age, 48.5+/-18.7 years; male-female ratio, 1.27). Sixty-seven patients (20%) had cirrhosis at histology. Logistic regression identified seven variables that predicted cirrhosis: age>or=60 years, platelet count<or=100 (x10/L), AST/ALT>or=1, prothrombin time (Ratio)>or=1.1, caudate hypertrophy, right lobe atrophy and splenomegaly. Patients scoring>or=22 in total had a statistically significant probability of cirrhosis (sensitivity, 80%; specificity, 96%; and diagnostic accuracy, 94%).


CONCLUSIONS
Cirrhosis can be predicted in patients with chronic hepatitis C by the evaluation of seven clinical, laboratory, and sonographic variables. The index will be useful for the management and follow-up of hepatitis C patients drastically reducing the indications for biopsy in this context.
Obrador
Blai Dalmau
BD
Unitat de Malalties Digestives, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain. bdalmau@cspt.es
Prades
Montserrat Gil
MG
Gómez
Mercedes Vergara
MV
Domingo
Jordi Puig
JP
Cueto
Rosa Bella
RB
Rué
Montserrat
M
Real
Jordi
J
Guiteras
Pere Mas
PM
D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000821:virology; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010976:Platelet Count; D011379:Prognosis; D011517:Prothrombin Time; D018615:Ultrasonography, Doppler, Color
D015415:Biomarkers