title: Occult cirrhosis diagnosed by transient elastography is a frequent and under-monitored clinical entity.
abstract: OBJECTIVE
  Diagnosis of preclinical compensated cirrhosis (occult cirrhosis, OC) is challenging due to lack of clinical findings. We evaluated prevalence and outcomes of OC by transient elastography (TE, Fibroscan(®)).
  
  
  METHODS
  Eight hundred and seventy-one patients with compensated chronic liver disease (CLD) and TE examination were divided into: (i) OC (TE ≥ 13 kPa and no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (ii) clinically evident cirrhosis (TE ≥ 13 kPa with signs of cirrhosis); (iii) non-cirrhotic CLD (TE < 13 kPa). Outcomes included hepatocellular carcinoma (HCC), esophageal varices and ascites. Late diagnosis of outcomes was defined as HCC stage ≥intermediate by BCLC or variceal bleeding.
  
  
  RESULTS
  Occult cirrhosis represented 12% of the cohort and 37% of cirrhotic patients. Independent predictors of OC were age [odds ratio (OR) 1.15; 95% confidence interval (CI), 1.04-1.26], HIV co-infection (OR 3.53; 95% CI, 1.85-6.76) and APRI (OR 2.63; 95 CI, 1.87-3.71). During a median follow-up of 24 (interquartile range 20-37) months, OC received less surveillance than clinically evident cirrhosis, with fewer ultrasounds (2.7 ± 1.5 vs 3.6 ± 2; P < 0.001) and gastroscopies (2 ± 0.8 vs 2.6 ± 1.4; P < 0.001). Incidence of outcomes was 3.5/100 per person-years (PY) (95% CI, 0.1-6.9) in OC, 0 in non-cirrhotic CLD and 9.8/100 PY (95% CI, 0.3-19.3) in clinically evident cirrhosis (P < 0.001). Late diagnosis occurred more in OC than clinically evident cirrhosis (60 vs 15%, P = 0.01).
  
  
  CONCLUSIONS
  Occult cirrhosis is a frequent and under-monitored clinical entity associated with short-term risk of outcomes. TE may help early diagnosis, prompt initiation of surveillance and specific therapy for an otherwise unrecognized condition.
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Tianyan
authors: T
authors: Chen
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Remy
authors: R
authors: Wong
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Philip
authors: P
authors: Wong
authors: Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
authors: Kathleen C
authors: KC
authors: Rollet-Kurhajec
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Rasha
authors: R
authors: Alshaalan
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Marc
authors: M
authors: Deschenes
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors: Peter
authors: P
authors: Ghali
authors: Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.|Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
authors: Giada
authors: G
authors: Sebastiani
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000473:pathology; D060085:Coinfection / Q000453:epidemiology; D042241:Early Diagnosis; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D005773:Gastroscopy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: chronic liver disease; esophageal varices; hepatocellular carcinoma; occult cirrhosis; surveillance; transient elastography