ACCURACY OF CLINICAL-DIAGNOSIS OF CIRRHOSIS AMONG ALCOHOL-ABUSING MEN

There is a considerable variation among specialists in the use of live r biopsy for the diagnosis of alcoholic cirrhosis, which is often base d solely on clinical findings, sometimes supplemented with blood tests . To assess the diagnostic accuracy that may be achieved by this appro ach, we related items of the history, symptoms and signs, and routine blood tests to the presence/absence of cirrhosis in a unique, previous ly established, consecutive series of 303 alcohol-abusing men, in whom liver biopsy was performed irrespective of the clinical and biochemic al findings. Using logistic regression analyses, we created a clinical , a combined clinical and biochemical, and a pure biochemical diagnost ic model. The probability of cirrhosis in patients with the specified characteristics was estimated, the diagnostic accuracy was assessed as functions of diagnostic thresholds for cirrhosis defined by the proba bility of cirrhosis varying between 0 and 1, and confidence intervals were estimated by bootstrap sampling. The clinical model, including fa cial teleangiectasia, vascular spiders, white nails, abdominal veins, fatness, and peripheral edema, could be used with high diagnostic accu racy and it was clearly superior to the biochemical model. Adding bioc hemical findings to the clinical model improved the accuracy of the cl inical model only slightly. We conclude that cirrhosis may be diagnose d in alcohol-abusing men with a high accuracy using selected, properly weighted clinical observations only.