Abstract
Backgrounds: This study aimed to achieve a better understanding of the characteristics of patients with cryptogenic cirrhosis (CC). Methods: We retrospectively enrolled 50 patients with CC between January 2018 and December 2020 who were admitted to our hospital. Clinical data, biochemical and immunological parameters, viral markers, imaging findings and liver histopathological features of the patients were analyzed. Results: The percentage of male patients with CC was 58% (29/50). The average age was 54 ± 17 years. Hepatitis C virus (HCV) IgG and hepatitis B surface antigen (HBsAg) were negative for all patients. Hepatitis B virus (HBV) DNA was tested in 68% (34/50) of the patients and the results were undetectable. Ceruloplasmin was detected in 96% (48/50) cases, while 10 cases were Kayser-fleischer ring negative. Immunological tests were conducted in 94% (47/50) of cases, antinuclear antibody (ANA) was elevated in eight cases, whereas anti-mitochondrial antibody (AMA) was elevated in three cases. Liver biopsy was conducted on 11 patients, of which seven were percutaneous and four were transjugular. Immunohistochemistry for HBsAg and HBcAg were all negative. Metavir scoring result showed that six of 11 patients had scores below G2S2. Conclusions: The common laboratory tests especially noninvasive ones were conducted for most of the patients. Diagnosis of CC requires further detection to exclude specific diagnosis such as HBV DNA or intrahepatic covalently closed circular DNA (cccDNA) in HBcAb positive patients, genetic screening of Wilson’s Disease in patients with low ceruloplasmin, etc.
Highlights
MethodsCryptogenic cirrhosis (CC) refers to cirrhosis whose etiology remains unclear after comprehensive evaluation[1]
In order to identify the underlying causes, it is necessary to screen the common causes of chronic liver disease before diagnosis, including viral hepatitis, autoimmune liver disease, alcoholic liver disease, drug-induced liver injury (DILI), vascular and biliary cirrhosis and genetic metabolic liver disease, which requires invasive examination
Hepatitis C virus (HCV) RNA was tested in 32% (16/50) of the patients whereas hepatitis B virus (HBV) DNA was tested in 68% (34/50) of the patients, and the results were undetectable
Summary
Cryptogenic cirrhosis (CC) refers to cirrhosis whose etiology remains unclear after comprehensive evaluation[1]. CC accounts for about 5-30% of all liver cirrhosis[2,3]. In order to identify the underlying causes, it is necessary to screen the common causes of chronic liver disease before diagnosis, including viral hepatitis, autoimmune liver disease, alcoholic liver disease, drug-induced liver injury (DILI), vascular and biliary cirrhosis and genetic metabolic liver disease, which requires invasive examination. Due to thrombocytopenia and coagulation dysfunction in most patients with liver cirrhosis, percutaneous liver biopsy is risky, whereas transjugular liver biopsy is not commonly performed since it requires specific technology. The reluctance of patients to accept an invasive examination is a drawback
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