Clinical meaning
Diagnosing cirrhosis has evolved from mandatory liver biopsy (Metavir F4) to validated non-invasive methods. FibroScan (transient elastography) measures liver stiffness using ultrasound-based shear wave velocity: <7 kPa is normal, 7-12.5 kPa suggests significant fibrosis, >12.5 kPa suggests cirrhosis (with >95% NPV for ruling out advanced fibrosis). Serum biomarker panels include FIB-4 (combining age, AST, ALT, platelets; >3.25 suggests advanced fibrosis), APRI (AST-to-platelet ratio index), and enhanced liver fibrosis (ELF) test. The Child-Pugh classification (A=5-6, B=7-9, C=10-15) uses bilirubin, albumin, INR, ascites, and encephalopathy to stage functional severity. The MELD score (using bilirubin, INR, creatinine) predicts 3-month mortality and determines transplant priority.
Diagnosis & workup
Diagnostics & workup: - FIB-4 index: (Age x AST) / (Platelets x √ALT); <1.30 rules out advanced fibrosis; >3.25 suggests advanced fibrosis/cirrhosis; intermediate values need further testing - FibroScan (transient elastography): >12.5 kPa suggests cirrhosis; limited by obesity (XL probe needed), ascites, and acute inflammation (false elevation) - APRI score: (AST/ULN x 100) / platelets; >2.0 suggests cirrhosis - Child-Pugh score: Bilirubin (1-3 pts), Albumin (1-3 pts), INR (1-3 pts), Ascites (1-3 pts), Encephalopathy (1-3 pts); Class A (5-6), B (7-9), C (10-15) - MELD score: 3.78 x ln(bilirubin) + 11.2 x ln(INR) + 9.57 x ln(creatinine) + 6.43; range 6-40; determines transplant prioritization - Liver biopsy: gold standard but invasive; reserved for diagnostic uncertainty, multiple potential etiologies, or assessing treatment response - Imaging features of cirrhosis: nodular liver contour, caudate lobe hypertrophy, splenomegaly, portal vein >13mm, ascites