From the Guidelines
Laboratory values in cirrhosis typically show several characteristic abnormalities that reflect liver dysfunction and its systemic effects, including decreased albumin, elevated bilirubin, prolonged prothrombin time, and increased INR, as well as thrombocytopenia and elevated liver enzymes. These abnormalities can be used to diagnose cirrhosis, assess its severity using scoring systems like MELD and Child-Pugh, monitor disease progression, and guide treatment decisions 1. Common findings in cirrhosis include:
- Decreased albumin (hypoalbuminemia) due to reduced liver synthesis
- Elevated bilirubin from impaired excretion
- Prolonged prothrombin time (PT) and increased INR reflecting decreased production of clotting factors
- Elevated liver enzymes such as AST and ALT, though these may normalize in advanced disease
- Thrombocytopenia due to splenic sequestration from portal hypertension
- Hyponatremia from fluid retention and dilution
- Elevated ammonia levels contributing to hepatic encephalopathy
- Decreased cholesterol
- Elevated alkaline phosphatase and GGT
- Increased alpha-fetoprotein in some cases
- Anemia from various causes including gastrointestinal bleeding, as shown by CBC results The Model for End-Stage Liver Disease (MELD) score, which incorporates serum bilirubin, creatinine, and international normalized ratio, is a useful tool for assessing liver dysfunction and predicting survival outcome in patients with cirrhosis 1. However, traditional coagulation testing, including INR or platelet count, does not accurately predict bleeding risk in patients with cirrhosis, and other factors such as presence of advanced Child-Turcotte-Pugh (CTP) cirrhosis or presence of ACLF contribute greatly to bleeding risk 1. Therefore, a comprehensive assessment of laboratory values, including MELD score and other relevant tests, is essential for managing patients with cirrhosis and reducing morbidity and mortality.
From the Research
Laboratory Values in Cirrhosis
- Laboratory tests are crucial in diagnosing and managing cirrhosis, with common tests including complete blood count, comprehensive metabolic panel, and prothrombin time 2
- Serum prealbumin, cholinesterase, and retinol binding protein levels have been found to be of potential clinical value in diagnosing liver cirrhosis complicated by encephalopathy 3
- Initial workup for cirrhosis includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography, as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio 4
Liver Function Tests
- Liver function tests, such as serum bilirubin, liver enzymes, serum albumin, and prothrombin time, partly assess liver functions, but have limitations in evaluating all functions of the liver 5
- Quantitative liver function tests, like indocyanine clearance tests and methacetin breath test, can assess dynamic status of the liver, but have their own limitations and availability 5
- Combinations of blood parameters, such as fibrosis score of 4, Lok index, and model for end-stage liver disease score, are commonly used for assessing liver function in clinical practice 5
Management of Cirrhosis
- Management of cirrhosis includes directed counseling, laboratory testing, and ultrasound monitoring, with treatment goals of preventing cirrhosis, decompensation, and death 4
- Symptom management in patients with cirrhosis can be challenging, but practical guidance is available for managing liver-specific symptoms, such as ascites and hepatic encephalopathy, as well as generalized symptoms, like pain and depression/anxiety 6