NONINVASIVE DIAGNOSIS OF HEPATIC-FIBROSIS OR CIRRHOSIS

Background & Aims: The evaluation of the degree of hepatic fibrosis is especially important in patients with chronic liver disease. The aim of this study was to study the diagnostic accuracy of noninvasive mean s. Methods: Sixty-three clinical, biochemical (prothrombin index, gamm a-glutamyl transpeptidase and apolipoprotein Al levels [PGA score];and hyaluronate, alpha(2)-macroglobulin, N-terminal peptide of type III p rocollagen, laminin, and transforming growth factor beta 1 levers), Do ppler ultrasonic, and endoscopic variables were recorded in 243 patien ts who were divided into four groups: whole, compensated, alcohol-comp ensated, and viral-compensated liver disease. Diagnostic accuracy was evaluated by discriminant analysis; first globally, then by stepwise a nalysis. Results: In three groups, hyaluronate and prothrombin index w ere the best predictive factors (accuracy, greater than or equal to 85 %). Accuracy for the diagnosis of cirrhosis varied from 89.5% to 95% w ith global discriminant analysis and from 91% to 94% with stepwise ana lysis according to the group. In the compensated group, hyaluronate co ncentration of greater than or equal to 60 mu g/L had a sensitivity of 97% and a specificity of 73%. Diagnostic accuracy was 87% globally fo r extensive fibrosis. Prothrombin index and hyaluronate were two indep endent variables predictive of the area of fibrosis (r(2) = .66). Conc lusions: With the use of a few noninvasive criteria, cirrhosis can be correctly diagnosed in 91%-94% of patients with chronic liver disease. Serum hyaluronate concentration is the most sensitive variable for sc reening.