Characteristics of cirrhosis undiagnosed during life: a comparative analysis of 73 undiagnosed cases and 149 diagnosed cases of cirrhosis, detected in 4929 consecutive autopsies

Abstract

In 4929 consecutive autopsies performed during a period of 4 years, 222 cases (4.5%) of cirrhosis were found, of which 149 (3%) were detected while the patients were alive (diagnosed cirrhosis) and 73 (1.5%) were not detected while the patients were living (undiagnosed cirrhosis). Fifty-three of the 73 undiagnosed patients appeared to be completely without signs of cirrhosis (silent cirrhosis). In the diagnosed group, 70% of patients died from hepatic causes, in contrast to 16% in the undiagnosed group. At autopsy, the following complications of cirrhosis were found more frequently in the diagnosed group than in the undiagnosed group: ascites (41% vs. 8%), oesophageal varices (44% vs. 10%), splenomegaly (52% vs. 29%). The prevalence of hepatocellular carcinoma did not differ significantly in the two groups (12% vs. 8%). It is concluded that cirrhosis without obvious signs occurs relatively frequently, and that no sensitive non-invasive screening methods are available at present.

FibroGENE: A gene-based model for staging liver fibrosis

“…However, the diagnosis of cirrhosis is frequently missed [44], with autopsy studies revealing that up to one third of patients are not identified during their lifetime [45]. Thus, segregating patients with mild or no fibrosis, and hence little chance of liver-related adverse outcomes, from those with more advanced disease or in fact cirrhosis, is crucial.…”

Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

“…On the other hand, cirrhosis is a common disease, which is frequently undiagnosed [4,5] . The risk of biopsy (morbidity 3%, mortality 0.03%) [7] may limit its use in screening for this disease.…”

“…Hepatic artery (HA) measurements included: diameter (D) in cm, cross-sectional area (AR) in cm 2 , time-averaged mean velocity (V TAM ) in cm/s and blood flow volume (BF) in mL/min. Resistance index (RI) of HA (percentage) was the ratio of 100 × the difference of peak systolic velocity minus end diastolic velocity to peak systolic velocity, automatically given by machine's software.…”

“…Cirrhosis often occurs as an indolent disease and a lot of patients remain asymptomatic [4,5] until the occurrence of decompensation, and are characterised by portal hypertension, variceal bleeding, ascites and hepatic encephalopathy.…”

“…Chronic viral hepatitis, mainly caused by hepatitis virus B or C, results in liver parenchyma damage and inflammation and may lead to fibrosis, cirrhosis and/or hepatocellular carcinoma [1][2][3] . Cirrhosis often occurs as an indolent disease and a lot of patients remain asymptomatic [4,5] until the occurrence of decompensation, and are characterised by portal hypertension, variceal bleeding, ascites and hepatic encephalopathy.…”