title: Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests.
abstract: 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.
authors.affiliation: Digestive Physiology, Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Forestier
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Marie
authors.initials: M
authors.lastname: Ecochard
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Delphine
authors.initials: D
authors.lastname: Lutringer
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Fabien
authors.initials: F
authors.lastname: Subtil
authors.forename: François
authors.initials: F
authors.lastname: Mion
mesh_terms: 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
chemical_list: D002247:Carbon Isotopes; D004396:Coloring Agents; D000632:Aminopyrine; D001219:Aspartate Aminotransferases; D007208:Indocyanine Green