What laboratory tests are used to monitor a patient with liver cirrhosis?

From the Guidelines

Laboratory tests used to monitor a patient with liver cirrhosis include:

• Platelet count: to assess for thrombocytopenia, a common complication of cirrhosis 1
• Prothrombin time (PT) and international normalized ratio (INR): to evaluate liver synthetic function, although these tests have limitations in cirrhosis 1
• Fibrinogen levels: to assess for coagulopathy, as low fibrinogen levels may increase bleeding risk 1
• Thromboelastography (TEG) or rotational thromboelastometry (ROTEM): to evaluate global hemostasis, although these tests have limitations and should be interpreted cautiously 1
• Liver function tests (LFTs): to monitor liver damage and dysfunction, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels
• Imaging studies: such as ultrasound, CT, or MRI, to assess for complications of cirrhosis, including hepatocellular carcinoma (HCC) and portal vein thrombosis 1

It is essential to note that:

• No single laboratory test can accurately predict bleeding risk in patients with cirrhosis 1
• A combination of laboratory tests and clinical assessment is necessary to evaluate the risk of bleeding and guide management decisions
• The use of viscoelastic tests, such as TEG and ROTEM, may be helpful in selecting patients who do not require preprocedural intervention, but further study is needed to define their role in clinical practice 1

From the Research

Laboratory Tests for Liver Cirrhosis

The following laboratory tests are used to monitor a patient with liver cirrhosis:

• Liver function tests (LFTs), which include:
  • AST (aspartate aminotransferase) 2, 3, 4
  • ALT (alanine aminotransferase) 4
  • Alkaline phosphatase 2, 4
  • Bilirubin 2, 3, 5, 4
  • Albumin 2, 5, 4
  • Prothrombin time (INR) 3, 5, 4
  • Gamma glutamyl transpeptidase (GGT) 3, 4
• Quantitative liver function tests, such as:
  • Indocyanine clearance tests (ICG-K) 4
  • Methacetin breath test (MBT) 4
• Imaging-based assessments, including:
  • Transient elastography 4
  • MRI-based 99mTc-coupled asialoglycoprotein mebrofenin scan 4
• Scoring indices, such as:
  • Child-Pugh score 6, 5, 4
  • Model for End-stage Liver Disease (MELD) score 6, 4
  • Fibrosis score of 4 (FIB-4) 4
  • Lok index 4

Frequency of Laboratory Tests

Laboratory tests should be performed regularly to monitor the patient's condition, with the frequency depending on the individual case. For example, clinical assessment with laboratory tests and calculation of the Child-Pugh and MELD scores should occur every 6 months 6.

Interpretation of Laboratory Tests

The interpretation of laboratory tests should be done in conjunction with clinical criteria to determine the severity of cirrhosis and evaluate the prognosis 5. The results of laboratory tests can also be used to guide further diagnostic evaluation and monitor the efficacy of therapy 2.