A Clinical Algorithm for Screening Compensated Advanced Chronic Liver Disease Utilizing Ultrasonography, Platelet...

Area of Science:

• Hepatology and Gastroenterology
• Diagnostic Imaging
• Non-invasive Liver Disease Assessment

Background:

• Compensated advanced chronic liver disease (cACLD) involves asymptomatic patients with advanced fibrosis but no signs of portal hypertension.
• Early detection of cACLD is crucial for risk stratification and preventing disease progression.
• Transient elastography (TE) is the primary diagnostic tool, but its accessibility may be limited.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of ultrasonography (USG) for detecting cACLD.
• To assess if combining USG findings with platelet count and serum albumin enhances diagnostic utility.
• To compare the proposed approach with existing non-invasive scoring systems for cACLD.

Main Methods:

• Retrospective cross-sectional study involving 1,528 patients with suspected liver disease.
• Patients underwent USG, TE, and blood tests; TE was used as the reference standard.
• Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of USG for cACLD.

Main Results:

• USG demonstrated a sensitivity of 64.6% and specificity of 78.2% for cACLD.
• USG had a high negative predictive value (NPV) of 90.7%, increasing to 92.7% when combined with normal albumin and platelet counts.
• Combining USG with low platelet and albumin levels improved positive predictive value (PPV) in patients with sonographic signs of liver disease.

Conclusions:

• USG alone has limited reliability for diagnosing cACLD but is valuable for excluding advanced fibrosis due to its high NPV.
• Adding platelet count and serum albumin levels to USG improves diagnostic accuracy for cACLD.
• This combined approach offers a cost-effective and practical initial assessment tool, potentially optimizing resource use where TE is less accessible.