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Occult cirrhosis diagnosed by transient elastography is a frequent and under‐monitored clinical entity
Author(s) -
Chen Tianyan,
Wong Remy,
Wong Philip,
RolletKurhajec Kathleen C.,
Alshaalan Rasha,
Deschenes Marc,
Ghali Peter,
Sebastiani Giada
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12802
Subject(s) - medicine , transient elastography , cirrhosis , gastroenterology , hepatocellular carcinoma , ascites , interquartile range , esophageal varices , chronic liver disease , odds ratio , liver disease , portal hypertension , occult , hepatology , pathology , liver fibrosis , alternative medicine
Background & Aims Diagnosis of preclinical compensated cirrhosis (occult cirrhosis, OC ) is challenging due to lack of clinical findings. We evaluated prevalence and outcomes of OC by transient elastography ( TE , Fibroscan ® ). Methods Eight hundred and seventy‐one patients with compensated chronic liver disease ( CLD ) and TE examination were divided into: (i) OC ( TE ≥ 13 kPa and no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (ii) clinically evident cirrhosis ( TE ≥ 13 kPa with signs of cirrhosis); (iii) non‐cirrhotic CLD ( TE < 13 kPa). Outcomes included hepatocellular carcinoma ( HCC ), esophageal varices and ascites. Late diagnosis of outcomes was defined as HCC stage ≥intermediate by BCLC or variceal bleeding. Results Occult cirrhosis represented 12% of the cohort and 37% of cirrhotic patients. Independent predictors of OC were age [odds ratio ( OR ) 1.15; 95% confidence interval ( CI ), 1.04–1.26], HIV co‐infection ( OR 3.53; 95% CI , 1.85–6.76) and APRI ( OR 2.63; 95 CI , 1.87–3.71). During a median follow‐up of 24 (interquartile range 20–37) months, OC received less surveillance than clinically evident cirrhosis, with fewer ultrasounds (2.7 ± 1.5 vs 3.6 ± 2; P < 0.001) and gastroscopies (2 ± 0.8 vs 2.6 ± 1.4; P < 0.001). Incidence of outcomes was 3.5/100 per person‐years ( PY ) (95% CI , 0.1–6.9) in OC , 0 in non‐cirrhotic CLD and 9.8/100 PY (95% CI , 0.3–19.3) in clinically evident cirrhosis ( P < 0.001). Late diagnosis occurred more in OC than clinically evident cirrhosis (60 vs 15%, P = 0.01). Conclusions Occult cirrhosis is a frequent and under‐monitored clinical entity associated with short‐term risk of outcomes. TE may help early diagnosis, prompt initiation of surveillance and specific therapy for an otherwise unrecognized condition.