Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests.
BACKGROUND
Recently, noninvasive methods for the diagnosis of liver cirrhosis have been extensively developed. We assessed the accuracy of liver stiffness measurement, aspartate aminotransferase-to-platelet ratio index (APRI) score, 13C-aminopyrine breath test, and indocyanine green plasma clearance for the diagnosis of cirrhosis in patients with chronic liver disease and for the prediction of severe complications in cirrhotic patients.


METHODS
A total of 296 consecutive patients with chronic liver diseases of various causes were studied. Diagnostic accuracy was assessed by receiver operating characteristic curve analysis.


RESULTS
Areas under the receiver operating characteristic curve for the diagnosis of cirrhosis were (95% confidence interval) 0.93 (0.90-0.96) for liver stiffness measurement, 0.82 (0.77-0.87) for 13C-aminopyrine breath test, and 0.81 (0.76-0.86) for APRI score. Using cutoff values of 14.1 kPa for liver stiffness, 4.15% dose/h for 13C-aminopyrine breath test, and 1 for APRI score, the positive predictive value was approximately 90% for the diagnosis of cirrhosis. Using cutoff values of 65.2 kPa for liver stiffness, 1.17% dose/h for 13C-aminopyrine breath test, 2.82 for APRI score, and 51.1% for indocyanine green plasma clearance, the positive predictive value was approximately 80% for the occurrence of severe complications among cirrhotic patients.


CONCLUSIONS
Liver stiffness measurement, 13C-aminopyrine breath test, indocyanine green plasma clearance, and APRI score are reliable noninvasive methods for the diagnosis of cirrhosis in patients with chronic liver diseases of various causes, and are also prognostic indicators for the occurrence of severe complications in cirrhotic patients.
Forestier
Julien
J
Digestive Physiology, Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Dumortier
Jérôme
J
Guillaud
Olivier
O
Ecochard
Marie
M
Roman
Sabine
S
Boillot
Olivier
O
Lutringer
Delphine
D
Scoazec
Jean-Yves
JY
Subtil
Fabien
F
Mion
François
F
D000328:Adult; D000368:Aged; D000632:Aminopyrine / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000097:blood*; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D004396:Coloring Agents / Q000493:pharmacokinetics; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D002247:Carbon Isotopes; D004396:Coloring Agents; D000632:Aminopyrine; D001219:Aspartate Aminotransferases; D007208:Indocyanine Green