From the Guidelines
For a new diagnosis of cirrhosis, I strongly recommend a comprehensive laboratory evaluation including liver function tests such as serum levels of bilirubin, aspartate aminotransferase, alanine transaminase, alkaline phosphatase, prothrombin time expressed as international normalized ratio, albumin, and platelet count, as well as complete blood count, blood urea nitrogen, and creatinine to assess kidney function. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of these tests in assessing hepatic function and functional reserve in patients with cirrhosis 1.
Necessary Laboratory Tests
The following laboratory tests are necessary for a new diagnosis of cirrhosis:
- Liver function tests:
- Serum levels of bilirubin
- Aspartate aminotransferase
- Alanine transaminase
- Alkaline phosphatase
- Prothrombin time expressed as international normalized ratio
- Albumin
- Complete blood count
- Blood urea nitrogen
- Creatinine to assess kidney function
- Platelet count as a surrogate for portal hypertension
Additional Testing
Additional testing may include US and MRI elastography to quantify the degree of cirrhosis-related fibrosis, non-focal liver biopsy, and transjugular liver biopsy with pressure measurements to further assess hepatic functional reserve 1. The Child-Pugh classification can be used to assess hepatic functional reserve, which incorporates laboratory measurements such as serum albumin, bilirubin, and prothrombin time, as well as clinical assessments of encephalopathy and ascites.
Importance of Early Detection
Early detection of complications like portal hypertension, ascites, and hepatic encephalopathy is crucial for appropriate management and improved outcomes. The recommended laboratory tests and additional testing can help determine the etiology of cirrhosis, assess disease severity, identify complications, and guide management decisions.
From the Research
Necessary Laboratory Tests for Cirrhosis Diagnosis
The following laboratory tests are necessary for a new diagnosis of cirrhosis:
- Viral hepatitis serologies 2
- Ferritin and transferrin saturation 2
- Complete blood count 2
- Liver function tests, including aspartate transaminase (AST) and alanine transaminase (ALT) 2, 3
- Prothrombin time/international normalized ratio (PT/INR) 2, 3
- Serum albumin 3
- Serum alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) 3
- Platelet count to assess for thrombocytopenia 4
- Hematological tests to assess for anemia and leukopenia 4
Additional Testing
Additional testing may be necessary based on demographics and risk factors, including:
- Aspartate transaminase to platelet ratio index (APRI) score 2
- Fibrosis 4 (FIB-4) score 2, 3
- FibroTest/FibroSure 2
- Nonalcoholic fatty liver fibrosis score 2
- Transient elastography 2, 3
- Imaging tests, such as ultrasonography and MRI 2, 3
Scoring Indices
Scoring indices, such as the Child-Pugh and Model for End-stage Liver Disease (MELD) scores, should be calculated to assess liver function and disease severity 5, 3. These scores can help guide management and treatment decisions.