Biological diagnosis of the different stages of liver disease in alcoholicpatients with abnormal serum liver tests

Objectives - The histological diagnosis of the different stages of alcoholi c liver disease is not systematic. The aim of this study was ro assess whet her common biological features were useful in identifying the different sta ges. Methods - One thousand twenty sh alcoholic patients with liver histology an d without any associated diseases or infections likely to alter serum liver tests were studied. Diagnostic analyses were performed using stepwise disc riminant analysis in the entire population and in asymptomatic patients. Results - a) Serum ASAT activity levels were only normal in 39% of the pati ents with normal histological liver and in 14% of the patients with steatos is; b) liver failure was already present in patients with fibrosis without cirrhosis; c) beta gamma block was the only biochemical parameter which con firmed the diagnosis of cirrhosis without biopsy; d) the diagnostic accurac y Of common tests was weak for the diagnosis of alcoholic liver disease wit hout cirrhosis but prothrombin rime could be useful in excluding the diagno sis of cirrhosis with and without acute alcoholic hepatitis when liver biop sy is not available. Conclusion - Only a prothrombin time of 80% with a negative predictive valu e of 94% and the presence of beta alpha block with a positive predictive va lue of 98% were useful for assessing the diagnosis of cirrhosis in all pati ents with alcoholic liver disease.