Cirrhosis Clinical prediction rules

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Sudarshana Datta, MD [3]

Hepatic fibrosis

  • FibroSure/FibroTest: α2-macroglobulin, apolipoprotein A1, haptoglobin, GGT, and total bilirubin. Age and sex

Indirect scores[1]:

Hepatic cirrhosis

Clinical prediction rules exist to help diagnosis cirrhosis.[3]

  • Pohl's Index is if the AST/ALT ratio ≥1 and platelet count ≤ 150,000/mm3 then cirrhosis is very likely.[4]
  • The Bonacini score is based on the ALT/AST ratio, platelet count, and INR.[5]
    • A score of > 7 or 8 makes cirrhosis more likely.[6]
    • A score of < 3 makes cirrhosis less likely.[6]

In diagnosis of cirrhosis (Ishak scores, 5-6) in patients with hepatitis C, the aspartate aminotransferase to platelet ratio index (APRI) ratio > 1 suggests cirrhosis with accuracy of:[7]

  • Sensitivity = 79%
  • Specificity = 78%


  1. 1.0 1.1 Angulo P, Bugianesi E, Bjornsson ES, Charatcharoenwitthaya P, Mills PR, Barrera F; et al. (2013). "Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease". Gastroenterology. 145 (4): 782–9.e4. doi:10.1053/j.gastro.2013.06.057. PMC 3931256. PMID 23860502.
  2. Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH; et al. (2011). "Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis". Hepatology. 53 (3): 726–36. doi:10.1002/hep.24105. PMID 21319189.
  3. Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL; et al. (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
  4. Borroni G, Ceriani R, Cazzaniga M, Tommasini M, Roncalli M, Maltempo C; et al. (2006). "Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C." Aliment Pharmacol Ther. 24 (5): 797–804. doi:10.1111/j.1365-2036.2006.03034.x. PMID 16918883.
  5. Colli A, Colucci A, Paggi S, Fraquelli M, Massironi S, Andreoletti M; et al. (2005). "Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C.". World J Gastroenterol. 11 (46): 7318–22. PMID 16437635.
  6. 6.0 6.1 Does this patient have cirrhosis? JAMA 2012
  7. Gara N, Zhao X, Kleiner DE, Liang TJ, Hoofnagle JH, Ghany MG (2013). "Discordance among transient elastography, aspartate aminotransferase to platelet ratio index, and histologic assessments of liver fibrosis in patients with chronic hepatitis C." Clin Gastroenterol Hepatol. 11 (3): 303–308.e1. doi:10.1016/j.cgh.2012.10.044. PMID 23142332.

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