Context:
Among adult patients with liver disease, the ability to identify those most likely to have cirrhosis noninvasively is challenging.
Objective:
To identify simple clinical indicators that can exclude or detect cirrhosis in adults with known or suspected liver disease.
Data sources:
We searched medline and embase (1966 to december 2011) and reference lists from retrieved articles, previous reviews, and physical examination textbooks.
Study selection:
We retained 86 studies of adequate quality that evaluated the accuracy of clinical findings for identifying histologically proven cirrhosis.
Data extraction:
Two authors independently abstracted data (sensitivity, specificity, and likelihood ratios [lrs]) and assessed methodological quality. random-effects meta-analyses were used to calculate summary lrs across studies.
Results:
Among the 86 studies, 19,533 patients were included in this meta-analysis, among whom 4725 had biopsy-proven cirrhosis (prevalence rate, 24%; 95% ci, 20%-28%). many physical examination and simple laboratory tests increase the likelihood of cirrhosis, though the presence of ascites (lr, 7.2; 95% ci, 2.9-12), a platelet count <160 x 10(3)/ฮผl (lr, 6.3; 95% ci, 4.3-8.3), spider nevi (lr, 4.3; 95% ci 2.4-6.2), or a combination of simple laboratory tests with the bonacini cirrhosis discriminant score >7 (lr, 9.4; 95% ci, 2.6-37) are the most frequently studied, reliable, and informative results. for lowering the likelihood of cirrhosis, the most useful findings are a lok index <0.2 (a score created from the platelet count, serum aspartate aminotransferase and alanine aminotransferase, and prothrombin international normalized ratio; lr, 0.09; 95% ci, 0.03-0.31); a platelet count โฅ160 x 10(3)/ฮผl (lr, 0.29; 95% ci, 0.20-0.39); or the absence of hepatomegaly (lr, 0.37; 95% ci, 0.24-0.51). the overall impression of the clinician was not as informative as the individual findings or laboratory combinations.
Conclusions:
For identifying cirrhosis, the presence of a variety of clinical findings or abnormalities in a combination of simple laboratory tests that reflect the underlying pathophysiology increase its likelihood. to exclude cirrhosis, combinations of normal laboratory findings are most useful.