Cirrhosis: Likelihood Ratios

Introduction: Irreversible chronic liver disease (insufficiency). Commonly caused by viral hepatitis (see HBV and HCV) or alcohol (see Alcoholism). See also Hepatic Encephalopathy.

For diagnostic signs, this provides a great review: http://www.turner-white.com/pdf/hp_jul03_stigmata.pdf

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Tags: Hepatic Tag this Diagnosis.

The likelihood ratios of findings for Cirrhosis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Jaundice

2.5

0.3

by clinical observation, for serum bilirubin >=3.0mg/dl.

Another study found sensitivity of only 68% for serum bilirubin >=2.5mg/dl.

Study: Acad Emerg Med. 2000 Feb;7(2):146-56. PMID: 10691073

Mil Med. 1997 Aug;162(8):560-3. PMID: 9271910

Poorly Diagnostic Findings

Gynecomastia

Sensitivity = 44%

obviously for male patients only. Specificity not assessed.

Study: Arch Intern Med. 1990 Mar;150(3):563-5. PMID: 2310274

Spider Angiomata

Sensitivity = 33%

50% prevalence in alcoholic cirrhosis vs 27% in non-alcoholic cirrhosis. Obviously they are not specific (since many occur with age or other hyper-estrogenic states in women), but this study did not address that question.

Study: Scand J Gastroenterol. 1999 May;34(5):520-3. PMID: 10423070

Findings With Unspecified Accuracy

Ascites

No accuracy specified.

see Ascites for diagnostic tests of ascites.

Study: no study specified.

Asterixis

No accuracy specified.

Study: no study specified.