Role of Ultrasound and Transient Elastography in Diagnosis of Occult Cirrhosis in Chronic Liver Disease

Abstract

Background: Hepatic cirrhosis represents the most advanced stage of any chronic liver disease characterized by progressive fibrosis. Complications including decompensation, spontaneous bacterial peritonitis, variceal bleeding, and hepatocellular carcinoma, carry significant morbidity and mortality. Early identification of patients with cirrhosis is of paramount importance to initiate surveillance protocols for prevention, early diagnosis, and specific therapies for such devastating complications. Objective: To investigate prevalence of preclinical cirrhosis diagnosed by transient elastography (TE) that we defined as occult cirrhosis (OC) and to evaluate the pattern of surveillance that patients with OC received in current clinical practice. Patients and methods: Our study included 60 chronic liver disease patients recruited from National Hepatology and Tropical Medicine Research Institute (NHTMRI) outpatient clinics to assess prevalence of occult cirrhosis among patients who have not any clinical or definite sonographic signs of liver cirrhosis, the study was divided into two groups: 1) Occult cirrhosis, defined as TE ≥13kPa and F4 on METAVIR scoring system. 2) non-cirrhotic chronic liver disease (CLD) (TE<13kPa). We found that the prevalence of OC is considerable, representing 15% of all CLD patients. This proportion suggests up to 1 in 7 individuals with CLD may have their OC missed. Results: Concerning the etiology of the chronic liver disease in our study, among the occult cirrhosis group there were 8 patients diagnosed as hepatitis C virus positive representing (89%) and one patient diagnosed as hepatitis B virus positive representing (11%) and among the non-cirrhotic group there were 42 patients diagnosed as hepatitis C virus positive representing (82%) and 4 patients diagnosed as hepatitis B virus positive representing (8%) and 5 patients diagnosed as non-alcoholic fatty liver disease (NAFLD) representing (10%). In our study among the occult cirrhosis group there were 5 male patients (55%) and 4 females (45%) with their age ranged between 33-55 years with the mean age 44 years and among the non-cirrhotic group there were 32 male patients (62.7%) and 19 female patients (37.3%) their age ranged between 19-58 years with the mean age 38.5 years. Conclusion: This study suggests that occult cirrhosis is a frequent finding. Clinicians should be aware that the absence of definite sonographic signs cannot rule out the possibility of compensated cirrhosis in its preclinical stage. Patients with occult cirrhosis can exhibit rapid development of hepatocellular carcinoma, variceal bleeding, and ascites.