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Clinical assessment of cirrhosis in severe chronic active liver disease: specificity and sensitivity of physical and laboratory findings.

The usefulness of certain physical and laboratory findings in predicting the morphologic diagnosis of cirrhosis in severe chronic active liver disease was determined in 101 patients, 39 of whom had cirrhosis. Hypoalbuminemia (69%) and hypergammaglobulinemia (67%) were the most common findings in cirrhosis, but they lacked specificity. Thrombocytopenia, hepatic encephalopathy, and ascites, which were the most specific and sensitive abnormalities, implicated cirrhosis with 85% assurance when present and occurred in the majority of patients with cirrhosis (56%). No single feature was pathognomonic of cirrhosis, although absence of all clinical findings excluded the diagnosis; Eight or more clinical abnormalities were invariably associated with cirrhosis, but only 18% of patients had such florid manifestations. The presence of at least five abnormalities was associated with a 76% likelihood of cirrhosis and was encountered in 56% of cirrhotic patients. Patients with three or fewer findings seldom had cirrhosis (24%), and only the presence of ascites reliably implicated the lesion in these patients. We conclude that in severe chronic active liver disease, recognition of certain specific findings or a constellation of abnormalities permits confident identification of cirrhosis in the majority of patients with this disorder.