Elsevier

Alcohol

Volume 66, February 2018, Pages 1-7
Alcohol

Evaluation of laboratory tests for cirrhosis and for alcohol use, in the context of alcoholic cirrhosis

https://doi.org/10.1016/j.alcohol.2017.07.006Get rights and content

Highlights

  • Evidence on test performance promotes better selection of appropriate tests.

  • We assessed laboratory tests for liver dysfunction, and for abstinence.

  • The subject group consisted of 1578 alcoholic patients, comprising 996 cirrhotic patients (631 abstinent) and 582 controls.

  • INR and bilirubin were the best tests for detecting alcoholic cirrhosis.

  • High GGT and AST cut-off values distinguish cirrhotic drinkers from abstainers.

Abstract

Laboratory tests can play an important role in assessment of alcoholic patients, including for evaluation of liver damage and as markers of alcohol intake. Evidence on test performance should lead to better selection of appropriate tests and improved interpretation of results. We compared laboratory test results from 1578 patients between cases (with alcoholic cirrhosis; 753 men, 243 women) and controls (with equivalent lifetime alcohol intake but no liver disease; 439 men, 143 women). Comparisons were also made between 631 cases who had reportedly been abstinent from alcohol for over 60 days and 364 who had not. ROC curve analysis was used to estimate and compare tests' ability to distinguish patients with and without cirrhosis, and abstinent and drinking cases. The best tests for presence of cirrhosis were INR and bilirubin, with areas under the ROC curve (AUCs) of 0.91 ± 0.01 and 0.88 ± 0.01, respectively. Confining analysis to patients with no current or previous ascites gave AUCs of 0.88 ± 0.01 for INR and 0.85 ± 0.01 for bilirubin. GGT and AST showed discrimination between abstinence and recent drinking in patients with cirrhosis, including those without ascites, when appropriate (and for GGT, sex-specific) limits were used. For AST, a cut-off limit of 85 units/L gave 90% specificity and 37% sensitivity. For GGT, cut-off limits of 288 units/L in men and 138 units/L in women gave 90% specificity for both and 40% sensitivity in men, 63% sensitivity in women. INR and bilirubin show the best separation between patients with alcoholic cirrhosis (with or without ascites) and control patients with similar lifetime alcohol exposure. Although AST and GGT are substantially increased by liver disease, they can give useful information on recent alcohol intake in patients with alcoholic cirrhosis when appropriate cut-off limits are used.

Section snippets

Background

Laboratory tests play an important role in the diagnosis and monitoring of patients with alcoholic cirrhosis, both for assessing the degree of impairment of liver function from cirrhosis and for detecting ongoing alcohol intake. It is important to share information on test performance, to optimize test selection and diagnostic accuracy.

Many aspects of liver function are impaired in cirrhosis, and form the basis of diagnostic or prognostic tests. These include excretory, synthetic, and metabolic

Methods

Information was gathered from patients recruited for the GenomALC Study (Whitfield et al., 2015) up to the end of April 2016. Recruitment occurred in Australia, France, Germany, Switzerland, UK, and USA, mainly from hepatology clinics (for cases, as defined below) and from psychiatric or detoxification facilities for the controls. All participants gave informed consent and the study was approved by appropriate Research Ethics Committees.

To be eligible, participants had to have high-risk alcohol

Results

The test means for abstinent and non-abstinent cases and controls are summarized in Table 2, with results for men and women shown separately in Supplementary Table 1. p values for both the effects of presence of cirrhosis and of abstinence on the means, and for case/control by abstinent/non-abstinent interaction, are also shown. Most of the tests showed differences between the case and control groups, but only AST and GGT showed significant effects of abstinence. These two tests also showed

Discussion

We have compared the performance of routine tests, and the composite MELD score, for distinguishing between patients with alcoholic cirrhosis (cases) and patients with similar lifetime exposure to alcohol but no liver disease (controls). The best of these tests show good discrimination, consistent with the comparison of selected groups and with clinical experience. We have also compared results from abstinent and non-abstinent patients with alcoholic cirrhosis. The tests that perform best for

Conclusions

We have documented and compared tests related to liver function in alcoholic cirrhosis, and have shown the best performance for INR and bilirubin. AST and GGT are increased by liver disease but they may still give useful information on recent alcohol intake in patients with alcoholic cirrhosis if appropriately higher and sex-specific cut-off values are used.

Acknowledgments

Recruitment, data, and sample collection were funded by grant AA018389 from the National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism. The contributions of all participants, and the work of personnel involved in specimen and data collection are gratefully acknowledged.

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