title: Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C.
abstract: BACKGROUND
  Biopsy is the gold standard for assessing cirrhosis in patients with chronic hepatitis C virus infection, but it is expensive and at risk of complications. Alternative non-invasive methods have been developed but their usefulness remains uncertain.
  
  
  OBJECTIVE
  To compare the accuracy of five non-invasive scores in detecting cirrhosis.
  
  
  METHODS
  We reviewed the charts and liver biopsies of 228 consecutive, treatment-naïve, hepatitis C virus-positive patients, 13.2% of whom with histological diagnosis of cirrhosis. The five alternative scores were age-platelet index, cirrhosis discriminant score, aspartate transaminases to platelet ratio index, Pohl's index, and aspartate transaminases/alanine transaminases ratio.
  
  
  RESULTS
  The specificities of the scores were good (87-100%), but not so their sensitivities (17-67%). Accordingly positive likelihood ratios were generally good but negative likelihood ratios were suboptimal. Combinations of the scores independently related to cirrhosis only slightly change this diagnostic accuracy. Using double cut-offs to exclude/diagnoses cirrhosis, cirrhosis discriminant score classified 21% of patients without misdiagnoses and aspartate transaminases to platelet ratio index classified 85% of case with 9% of misdiagnoses.
  
  
  CONCLUSIONS
  The five scores showed variable sensitivities and specificities in detecting liver cirrhosis, both individually and in combination. The use of double cut-off points may make the cirrhosis discriminant score and aspartate transaminases to platelet ratio index useful to reduce the number of patients submitted to liver biopsy.
authors.affiliation: Dipartimento Dipendenze, ASL Provincia di Milano 1, Legnano (MI), Italy. noaabbiategrasso@libero.it
authors.forename: G
authors.initials: G
authors.lastname: Borroni
authors.forename: R
authors.initials: R
authors.lastname: Ceriani
authors.forename: M
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: M
authors.initials: M
authors.lastname: Tommasini
authors.forename: M
authors.initials: M
authors.lastname: Roncalli
authors.forename: C
authors.initials: C
authors.lastname: Maltempo
authors.forename: C
authors.initials: C
authors.lastname: Felline
authors.forename: F
authors.initials: F
authors.lastname: Salerno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin