title: Automatic detection of cirrhosis in hospitalized patients: a pragmatic experience.
abstract: OBJECTIVE
  We evaluated the relevance of a systematic automatic detection of cirrhosis using biochemical markers in hospitalized patients.
  
  
  METHODS
  We automatically calculated three free biochemical tests (APRI, Fib-4, and Forns) in patients consecutively hospitalized in our university hospital between July and September, 2010. Patients >18 years not known to suffer from chronic liver disease, were contacted to undergo liver stiffness measurement (LSM) as a reference diagnostic tool. To limit false positives, we required at least one APRI≥2 (indicating cirrhosis) and Fib-4>3.25 and/or Forns>6.9, without obvious overestimation.
  
  
  RESULTS
  A total of 10,035 APRI, 9903 Fib-4, and 1250 Forns were available in 4074 patients. The fibrosis tests were independently influenced by the location of the patient, especially Cardiology (Lower Forns) and Hematology/Oncology Departments (higher APRI, Fib-4, and Forns). Overall, 101 patients (2.48%) were suspected to have cirrhosis. LSM identified two cases of cirrhosis (LSM>13 kPa). In intent-to-diagnose analyses, the highest positive predictive values of the APRI, Fib-4, and Forns for the diagnosis of cirrhosis were 1.98, 1.98, and 11.76%, respectively. The positive predictive value never exceeded 50% in per-protocol analyses when considering patients with numerous positive results of the fibrosis tests.
  
  
  CONCLUSIONS
  In hospitalized patients, automatic detection of cirrhosis on the basis of APRI, Fib-4, and Forns was inefficient because of too many false-positive results.
authors: aHepatology Department bDepartment of Medical Information cDepartment of Biochemistry dDepartment of informatics eDepartment of Clinical Pharmacology, Besançon University Hospital and University of Franche Comté, France.
authors: Laure
authors: L
authors: Lavaill
authors: Alain
authors: A
authors: Dussaucy
authors: Karine
authors: K
authors: Bardonnet
authors: Nicolas
authors: N
authors: Duraffourg
authors: Elisabeth
authors: E
authors: Monnet
authors: Thierry
authors: T
authors: Thévenot
authors: Siamak
authors: S
authors: Davani
authors: Vincent
authors: V
authors: Di Martino
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase