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