Liver Shrinkage (Cirrhosis): Test and Diagnosis

1st-order laboratory parameters-obligatory laboratory tests.

  • Small blood count [thrombocytopenia (lack of platelets); anemia (anemia)]
  • Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT) [only mildly elevated or normal], glutamate dehydrogenase (GLDH), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase, bilirubin [bilirubin ↑]
  • CHE (cholinesterase) [CHE ↓, as a sign of liver synthesis disorder]
  • Coagulation parameters – INR (Quick) [INR ↑], antithrombin III (clotting factors) [AT-III ↓]
  • Albumin in serum – important protein (protein) [albumin ↓, as a sign of liver synthesis disturbance].
  • APRI test (synonyms: AST (= aspartate aminotransferase) = GOT (glutamate oxaloacetate transaminase))/platelet ratio index, AST-to-platelet ratio index):AST / GOT [U/l]: platelet count [x 109/l or x 1,000/µl]Assessment:
    • Fibrosis is considered virtually excluded at values < 0.5
    • At values > 1.5 fibrosis is very likely
    • With values > 2 is a liver cirrhosis present

    The sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, that is, a positive test result occurs) for detecting liver cirrhosis is reported to be 38-57%, with a specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy in the test) of 87-93%.

  • MELD (= Mayo model for endstage liver disease): MELD score composed of: INR (Quick), bilirubin [mg/dl], creatinine [mg/dl].

Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.

  • Ammonia – parameter of detoxification performance of the liver [ammonia ↑]Note: Elevated ammonia levels are not suitable for diagnosis, severity classification or prognosis assessment in patients with liver cirrhosis hepatic encephalopathy (liver-brain disorder).
  • Hepatitis markers (laboratory parameters indicating liver inflammation), such as:
    • HCV antibodies – in the case of hepatitis C.
    • HBs-Ag, anti-HBc, anti-HBc IgM – in the presence of hepatitis B.
    • Anti-HAV IgM, anti-HAV IgG or HAV antigen detection – in the case of hepatitis A.
  • Autoantibodies (antibodies directed against structures in the patient’s own body) – such as AMA (antimitochondrial antibody) or pANCA (perinuclear anti-neutrophil cytoplasmic antibody).
  • Alpha-fetoprotein (AFP) – for screening (every 6 months) or suspected hepatocellular carcinoma [sonography of the liver is more sensitive; thus, only as an adjunct to sonography controls].
  • Serum ferritin – if hemochromatosis (iron storage disease) is suspected.
  • Alpha-1 antitrypsin – to exclude alpha-1 antitrypsin deficiency.

Further notes

  • Troponin I and BNP are frequently elevated without corresponding ischemic ECG changes