ArticleCureus2024
A Clinical Algorithm for Screening Compensated Advanced Chronic Liver Disease Utilizing Ultrasonography, Platelet Count, and Albumin Levels, With Transient Elastography as Reference.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims Compensated advanced chronic liver disease (cACLD) refers to asymptomatic patients with advanced fibrosis who do not yet exhibit clinical or radiological signs of portal hypertension. Early detection of cACLD is essential for effective risk stratification and timely management, potentially preventing progression to more severe and irreversible stages of liver disease. Transient elastography (TE) is the primary diagnostic method for cACLD, with several diagnostic thresholds commonly used. Ultrasonography (USG) is widely used as an initial diagnostic tool for liver disease, but its effectiveness in diagnosing cACLD is not well established. To the best of our knowledge, this study is the first to systematically evaluate the diagnostic accuracy of USG in detecting cACLD, using TE as a reference standard based on validated diagnostic thresholds. We also examined whether combining USG findings with platelet count and serum albumin could enhance diagnostic utility. Additionally, we discuss the strengths and limitations of established non-invasive scoring systems, including the Enhanced Liver Fibrosis (ELF) test, Fibrosis-4 (Fib-4) index, and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS), to determine if our approach offers a more accessible and practical solution in clinical settings Methods This retrospective cross-sectional study was conducted at the Royal Wolverhampton NHS Trust, Wolverhampton, England, including patients with suspected liver disease who underwent USG, TE, and blood tests. Valid TE readings followed manufacturer guidelines, and patients with USG-detected portal hypertension or confounding conditions (e.g., acute hepatitis, heart failure) were excluded. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of USG against TE, with TE values >15 kPa confirming and <10 kPa excluding cACLD. Results Among 1,528 patients (mean age 51 years, range 16-89), 982 were male (64.3%) and 546 were female (35.7%). The cohort predominantly comprised Caucasian (n=1,087, 71.1%) and South-East Asian (n=256, 16.8%) patients. USG showed a sensitivity of 64.6% (95%CI: 58.3-70.6%) and specificity of 78.2% (95%CI: 75.6-80.6%) for cACLD, with a PPV of 40.2% (95%CI: 36.7-43.7%) and an NPV of 90.7% (95%CI: 89.2-92.1%). High NPV was consistent across all etiologies. In patients with a normal liver on USG, NPV improved to 92.7% (95%CI: 90.9-94.6%) when serum albumin >35 g/L and platelet count >150 x 10
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