diagnosing advanced fibrosis or Cirrhosis

[spectda]

I am fully aware that there is no better tool then a biopsy to diagnose liver condition. I am not well informed about other tools, blood values etc that often indicate cirrhosis besides low platelets. Any help would be appreciated.
Thanks,
Dave

[paen53]

Thanks for that sobering article on CD. As one with compensated cirrhosis, I often naively focus on having attained SVR as the goal with the belief that some reversal is possible over time.

But this article, and a recent post by someone that cleared the virus in 2007 and still ended up transplanting earlier this year, is a real heads up about not getting too lax about my overall health post tx, especially with its connection to liver health. I also remember a couple posts about weight reduction - I think Goofy was told by his Dr. not to get fat on him - and yet another's Dr. that recommended striving for a runner's body.

Pam

[mikesimon]

"The only way to be certain of cirrhosis, to know severe it is and to try to identify the cause of cirrhosis, is to undergo a liver biopsy."

I don't think that is 100% accurate.
I never underwent a biopsy before I was transplanted but the transplant surgeons/hepatologists knew I had HCV and they knew I was cirrhotic. Sometimes a biopsy is not necessary, indicated or even helpful.
I knew several other transplant recipients who also did not undergo liver biopsy prior to transplantation.

Mike

[ann61]

Your insight was extremely valuable.  Thanks.

[mikesimon]

Obesity Linked to Risk for Decompensation of Cirrhosis

July 29, 2011 — Obesity is an independent risk factor for clinical decompensation (CD) in patients with cirrhosis, according to the results of a prospective observational study from the Portal Hypertension Collaborative Group reported online June 26 and to appear in the August print issue of Hepatology.

"Given the prior evidence of the detrimental effects of obesity on chronic liver disease, we hypothesized that increased BMI [body mass index] may increase the risk of transition from compensated to decompensated cirrhosis," said second author Guadalupe Garcia-Tsao, professor of medicine at Yale University School of Medicine in New Haven, Connecticut, in a news release.

Although obesity was previously known to be associated with an aggressive course in patients with chronic viral hepatitis, its effect on patients with established cirrhosis has been undetermined. The investigators therefore assessed the effect of obesity in patients with compensated cirrhosis, in conjunction with that of other known risk factors, on the development of CD.

The study sample consisted of 161 patients with compensated cirrhosis in whom data on BMI were available and who were enrolled in a randomized trial of beta-blockers to prevent varices. At study enrollment, participants underwent laboratory testing and measurement of portal pressure with use of the hepatic venous pressure gradient (HVPG). Follow-up continued until development of CD, defined as ascites, hepatic encephalopathy, or variceal hemorrhage, or until September 2002. Median duration of follow-up was 59 months.

At enrollment, 29% of participants had a normal BMI, 40% were overweight, and 30% were obese. CD occurred in 48 (30%) of 161 patients during follow-up. Rate of CD increased with increasing BMI: 15% in those with a normal BMI, 31% in the overweight group, and 43% in the obese group (P = .011). The groups with an abnormal BMI had a significantly higher actuarial probability of the development of CD (P = .022).

BMI was an independent predictor of CD (hazard ratio, 1.06; 95% confidence interval, 1.01 - 1.12; P = .02), as were HVPG and albumin, in a multivariate model that included factors previously determined to predict CD (HVPG, albumin level, Mayo end-stage liver disease score), cause, and treatment group.

"Patients who are overweight or obese are at greater risk of accelerating the progression of cirrhosis," Dr. Garcia-Tsao said. "Weight reduction may improve patient outcomes in this high-risk population and studies addressing this specific issue are warranted."

Limitations of this study include the fact that the original trial was not performed with the objective of evaluating the impact of obesity on CD.

"[I]ncreased BMI is an independent predictor of clinical decompensation in patients with compensated cirrhosis of various etiologies, suggesting that obesity accelerates the progression of cirrhosis and that its correction could be a valuable nonpharmacological measure to improve prognosis in this patient population," the study authors conclude.

The National Institutes of Health and the Instituto de Salud Carlos III supported this study. The study authors have disclosed no relevant financial relationships

http://www.medscape.com/viewarticle/747237?sssdmh=dm1.706462&src=nldne

[curiouslady1]

Wonderful post Hector.

[spectda]

A lot of really good information from everyone. Thank you for the thorough explanation hector.
-Dave

[HectorSF]

Hi Dave.

So you are asking for other ways of diagnosing cirrhosis?

Doctors can diagnose cirrhosis without a biopsy, but it is more of an educated guess than a certainty.

Okay first lets talk about the two types of cirrhosis. "Compensated" and "decompensated".
"Decompensated cirrhosis" is the easiest to diagnose because a person will have complications and symptoms of liver disease at that point.

Sign of "Decompensated cirrhosis": When the liver is so damaged it can no longer perform all of its functions.

Blood levels:
Low Albumen
High bilirubin
High creatinine
High INR

Symptoms/complications:
Extreme fatigue
ascites and/or edema in the feet, ankles, legs
Vomiting blood due to variceal bleeding
Hepatic encephalopathy - confusion to coma
Yellow discoloration of the skin and eyes (jaundice)
Loss of muscle mass in arms and legs
Tendency to bleed and bruise easily
skin changes (spider angiomata and palmar erythema)
Any many more nasties...

Now the signs of "compensated cirrhosis" are much more subtle and harder to diagnose then decompensated cirrhosis. You may feel perfectly normal and have compensated cirrhosis.

Indicators:
Scans such as ultrasound, CT or MRI, which can be useful in determining the appearance of structural changes in the liver (scaring and nodal surface).
Portal hypertension
Enlarged spleen
low platelet count -  (your other blood tests that measure liver function bilirubin, INR, creatinine may be within norms even AST and ALT can be within norms for some minority of people).

The MELD score and Child’s-Pugh-Turcotte score (CPT score) are used to measure the severity of the cirrhosis.
Here is a link to the UNOS MELD score calculator.
http://www.mayoclinic.org/meld/mayomodel6.html

Here is a link to CPT score calculator.
http://homepage.mac.com/sholland/contrivances/childpugh.html

The only way to be certain of cirrhosis, to know severe it is and to try to identify the cause of cirrhosis, is to undergo a liver biopsy.

So obviously there is a lot more to say on the subject but I hope this helps to answer your question.

Hector

[spectda]

Thanks for the information everyone.

[willbb]

.

a fourth blood  is low albumin   als o often U/S  shows size ,,nodular formation enlarged spleen, size of portal vein    as well I believe sometimes MRI and /or  CT

[FlGuy]

I think two others are INR and platelets.

Way back I went to see a GI (sees a lot of HCV but he's not a liver head).  First thing he said when I got in the exam room was you "got cirrhosis".  I did not have a bx at that time.  He based his guess on red palms and spider nevi.  Later, proved correct and confirmed by a real live liverhead.

Point is, that there objective indicators and apparently some subjective factors that go into a complete diagnosis with all relavent information considered.  That's what it's important to get a doc who has a lot of HCV experience, not just HCV as a sidelight to endo and colon scopes.

[nygirl7]

High bilirubin I think is one way.  I'm not too knowledgable either...I'm sure Mike or Hector will be around to tell you something more concrete Dave.