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

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Hepatic Tag this Diagnosis.

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

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

History
Finding	Result	+LR	-LR
[ + ] Jaundice	+ 0 -	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

Physical Exam
Finding	Result	+LR	-LR
[ + ] Jaundice	+ 0 -	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

Untagged
Finding	Result	+LR	-LR
[ + ] Ascites		No accuracy specified.
see Ascites for diagnostic tests of ascites. Study: no study specified.
[ + ] Asterixis		No accuracy specified.
Study: no study specified.
[ + ] 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