Occult liver disease burden: Analysis from a large general practitioners’ database

Abstract

Background: Cirrhosis represents the end stage of chronic liver disease, characterized by high mortality and morbidity. The prevalence of liver disease is difficult to assess, given its clinical latency up to the late stage. Objective: We aimed to assess the prevalence of unrecognized chronic liver disease and cirrhosis using surrogate indicators from medical records of family physicians. Methods: Medical records of 139,104 subjects, collected from 99 family physicians of the Veneto region, were used. Persistently high transaminases were used as indicators of occult chronic liver disease; thrombocytopenia, unrelated to haematological malignancies, was used as indicator of occult cirrhosis. Diagnosis of chronic liver disease and cirrhosis was assessed using ICD9-CM-1997 codes. Results: Alteration of transaminases was found in 32.7% of the subjects, and among them only one-third had an already diagnosed liver disease. Patients with diagnosis of cirrhosis were 0.3%, while thrombocytopenia, indicator of occult cirrhosis, was detected in 1.3% of the remaining population. Patients with overt and occult cirrhosis showed a higher metabolic profile, with significantly higher prevalence of arterial hypertension, obesity and diabetes than the general population. Conclusion: A large proportion of patients with chronic liver disease is still undiagnosed. Surrogate biochemical indicators might be useful for disease recognition.

Undiagnosed abnormal alanine transaminase levels in vulnerable populations: Impact of sex, race/ethnicity, and body mass

“…[2][3][4] These tests, particularly alanine transaminase (ALT) reflect hepatic injury, and when abnormal, require further work up as outlined in societal guidelines. 5 Despite frequent testing 3,4,6 and accessible recommendations for work up, 5,7,8 CLD may remain undiagnosed, 9 and those disproportionately affected by socioeconomic barriers are at greatest risk. 10,11 Abnormal ALT levels are relatively common and are estimated to range from 10% to 22% in the general population with variation due to different cut-off levels, or by sex, race/ethnicity and prevalence of elevated body mass index (BMI).…”

MELD-Na Score as a Predictor of Postoperative Complications in Ventral Skull Base Surgery

“…6 10 11 12 13 14 However, chronic liver disease is often silent until the late stages, and it is estimated that a large proportion of affected patients remain undiagnosed. 20 21 22 23 For example, one study found that nearly half of patients presenting to an otolaryngology department with head and neck squamous cell carcinoma also had undiagnosed liver disease. 12 Other studies report more modest, though still significant, estimates of liver disease incidence in patients undergoing head and neck surgery (6.8% in aerodigestive tract surgery, 4.3% in craniotomies for tumor removal).…”

“…6 Chronic liver disease can frequently be asymptomatic until the late stages and it is likely that a large proportion of afflicted patients remain undiagnosed. [20][21][22][23] MELD-Na scoring provides a solution to this problem and allows for identification of at-risk surgical candidates.…”

Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis

“…The abdominal CT scan showed a normal liver but later, the liver biopsy confirmed the diagnosis of cirrhosis. A study from Italy in 2017 reported that liver disease was undiagnosed or unrecognized in two thirds of cases [ 11 ]. Another paper from Canada found that occult cirrhosis was frequent and represented 37% of cases of cirrhosis [ 12 ].…”