![]() Identification of those individuals with treatable disease, such as HCV, HBV, and autoimmune hepatitis, may slow or even reverse fibrosis and early cirrhosis. Identification of affected individuals is critical to help mitigate the progression of disease and, more importantly, identify those with end stage liver disease who are at significant risk for decompensation. Because of the morbidity and mortality associated with CLD and cirrhosis, there is significant utilization of health care resources. Our goal was to identify any common laboratory value or pattern that would help identify the individuals with advanced liver disease.ĬLD and cirrhosis have gained increasing attention due to the newly approved therapies for hepatitis C and the increasing obesity epidemic. In order to determine whether commonly used laboratory tests are valuable to identify patients with chronic liver injury, we conducted a retrospective study on 771 liver biopsies done at our institution and evaluated the laboratory values for each stage of fibrosis and cirrhosis. Laboratory studies such as LFTs identify some but not all patients with significant liver injury. Identifying individuals at risk for chronic liver injury requires a high index of suspicion and a thorough history and physical examination. However, there has been very little published data comparing the changes in laboratory values and stages of fibrosis. 13– 18 Most clinicians associate both acute and CLD with abnormal liver function tests (LFTs). Recently, there has been extensive interest in finding reliable non-invasive methods to diagnose the stage of liver disease via serological (APRI, FIB-4, Forns index, and FibroTest) and radiological (ultrasound and MRI elastography) tests. 12 In the USA, hepatitis C, hepatitis B, alcoholic liver disease, and non-alcoholic fatty liver disease (NAFLD) are the important causes of chronic liver injury and progressive fibrosis. Hepatic dysfunction and portal hypertension complicate cirrhosis as the liver decompensates. 11 Regardless of the etiology, prolonged inflammation leads to chronic liver injury, fibrosis, and often cirrhosis. This model assesses the extent and location of the fibrosis, accompanying changes in parenchymal architecture and is expressed on a linear numerical scale of stage 0 (no fibrosis) to stage 4 (cirrhosis). Although there are several proposed schemes to stage fibrosis, the Batts and Ludwig system is most commonly used by pathologists in the USA. Liver biopsy has been the gold standard for evaluating liver injury and staging the disease. 6– 10 The extent and severity of the fibrosis on a liver biopsy determines the stage of the disease. Once activated HSCs release chemokines, the affected regions of liver parenchyma undergo unregulated deposition of the extracellular matrix resulting in the development of fibrosis. HSCs play the most pivotal role in liver fibrogenesis and are the target of interest for future therapeutic modalities to prevent or reverse advanced hepatic fibrosis. 5 This sustained liver injury leads to hepatocellular injury and excessive deposition of collagen by activated hepatic stellate cells (HSCs). Regardless of the etiology of the liver disease, these individuals undergo chronic persistent inflammation and progressive fibrosis, which leads to cirrhosis. Patients seek medical attention when the liver can no longer maintain homeostasis and begins decompensating with the onset of ascites, variceal bleeding, spontaneous bacterial peritonitis, encephalopathy, or jaundice. 4 Due to the large functional reserve in the liver, most patients with CLD go undiagnosed until late in the course of the disease. Moreover in that study, 70% of the patients found to have cirrhosis were unaware of their disease. 3 This could represent a gross underestimation of 1 in 370 (0.27%) as suggested in a recent study by Scagilone et al, where the prevalence was estimated based on the 2010 US census. The prevalence of cirrhosis in the general population is difficult to determine and was estimated to be 1 in 679 (0.15%) in a recent study published by the National Institute of Health (NIH). This number is expected to increase steadily well in the next decade. 1, 2 In 2010, the National Center for Health Statistics (NCHS) and Centers for Disease Control and Prevention (CDC) reported 31,903 deaths from CLD and cirrhosis. Both CLD and cirrhosis are the fifth leading cause of death in the 45–61 age group and 12th leading cause overall. Chronic liver disease (CLD) is a major cause of morbidity and mortality and is quickly becoming an increasing burden on the health care system.
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