Subject(s)
Blood Coagulation Tests , Colonoscopy , Gastrointestinal Hemorrhage/prevention & control , Hemorrhagic Disorders/diagnosis , Preoperative Care/methods , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Blood Coagulation Tests/statistics & numerical data , Colonic Neoplasms/diagnosis , Colonic Neoplasms/prevention & control , Colonic Neoplasms/surgery , Colonic Polyps/diagnosis , Colonic Polyps/surgery , Colonoscopy/adverse effects , Comorbidity , Female , Gastrointestinal Hemorrhage/etiology , Hemorrhagic Disorders/complications , Humans , Intestinal Diseases/diagnosis , Male , Middle Aged , Risk Factors , Unnecessary Procedures , Young AdultABSTRACT
OBJECTIVE: To perform a prospective validation and comparative analysis of two ultrasonographic diagnostic scores of cirrhosis in patients with silent liver disease. DESIGN: cross-sectional study, prospective and blind. ROC curves evaluated the diagnostic utility of: a) Bologna score (BS): assessment of liver surface nodularity and portal flow velocity, and b) Cadiz score (CS): assessment of liver echo structure, portal vein caliber and spleen area. Liver biopsy was considered the gold standard for the diagnosis of cirrhosis. PATIENTS: One hundred and thirteen patients, 76 men and 37 women, mean age 44 years old (range 18-73 years) referred for evaluation of chronic liver disease without clinical or biochemical evidence of advanced disease (absence of jaundice, ascites, encephalopathy, malnutrition or coagulopathy). RESULTS: Cirrhosis was diagnosed in 25 patients (22.1%). BS: sensitivity 84%, specificity 79.5%, area under the ROC curve 86.7%. CS: sensitivity 84%, specificity 89.8%, area under the ROC curve 92.4%. Portal vein was not displayed in 7 patients(6%) and portal flow velocity was not recorded in 13 (11.5%). These results agree with those obtained in the original articles developing both scores. There were no statistically significant differences between the two scores. Specificity reached 97% with joint use of both models, but sensitivity decreased to 72%. CONCLUSIONS: Presence or absence of cirrhosis in patients with silent liver disease can be established by Doppler ultrasound with high diagnostic accuracy. The joint use of both scores has high diagnostic specificity. Both diagnostic models are highly re-producible.
Subject(s)
Liver Cirrhosis/diagnostic imaging , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Models, Theoretical , Prospective Studies , Sensitivity and Specificity , Ultrasonography , Young AdultABSTRACT
Objetivo: realizar una validación prospectiva y un análisis comparativo de dos escalas de diagnóstico ecográfico de cirrosis en pacientes con enfermedad hepática silente. Diseño experimental: estudio transversal, prospectivo y ciego. Mediante curvas ROC se evaluó la utilidad diagnóstica de: a) escala de Bolonia (EB): valoración de la nodularidad de la superficie hepática y la velocidad de flujo portal; y b) escala de Cádiz (EC): valoración de la ecoestructura hepática, calibre portal y área esplénica. La biopsia hepática se consideró el estándar para el diagnóstico de cirrosis. Pacientes: ciento trece pacientes, 76 varones y 37 mujeres con edad media de 44 años (18-73) remitidos para estudio de una hepatopatía crónica sin indicios clínicos ni bioquímicos de enfermedad avanzada (ausencia de ictericia, ascitis, encefalopatía, malnutrición ni coagulopatía, actuales ni previas). Resultados: veinticinco pacientes (22,1%) fueron diagnosticados de cirrosis. EB: sensibilidad 84%, especificidad 79,5%, área bajo la curva ROC 86,7%. EC: sensibilidad 84%, especificidad 89,8%, área bajo la curva ROC 92,4%. La vena porta no se visualizó en 7 pacientes (6%) y la velocidad de flujo portal no se determinó en 13 (11,5%). Estos resultados son superponibles a los obtenidos en los artículos originales. No se encontraron diferencias estadísticamente significativas entre ambas escalas. El empleo conjunto de los dos modelos incrementó la especificidad diagnóstica hasta el 97% con una sensibilidad del 72%. Conclusiones: la presencia o ausencia de cirrosis en pacientes con enfermedad hepática silente puede ser establecida mediante ecografía con una elevada precisión diagnóstica. El empleo conjunto de ambas escalas alcanza una elevada especificidad diagnóstica. La reproducibilidad de ambas escalas es excelente(AU)
Objective: to perform a prospective validation and comparative analysis of two ultrasonographic diagnostic scores of cirrhosis in patients with silent liver disease. Design: cross-sectional study, prospective and blind. ROC curves evaluated the diagnostic utility of: a) Bologna score (BS): assessment of liver surface nodularity and portal flow velocity, and b) Cadiz score (CS): assessment of liver echostructure, portal vein caliber and spleen area. Liver biopsy was considered the gold standard for the diagnosis of cirrhosis. Patients: one hundred and thirteen patients, 76 men and 37 women, mean age 44 years old (range 18-73 years) referred for evaluation of chronic liver disease without clinical or biochemi - cal evidence of advanced disease (absence of jaundice, ascites, encephalopathy, malnutrition or coagulopathy) . Results: cirrhosis was diagnosed in 25 patients (22.1%). BS: sensitivity 84%, specificity 79.5%, area under the ROC curve 86.7%. CS: sensitivity 84%, specificity 89.8%, area under the ROC curve 92.4%. Portal vein was not displayed in 7 patients (6%) and portal flow velocity was not recorded in 13 (11.5%). These results agree with those obtained in the original articles developing both scores. There were no statistically significant differences between the two scores. Specificity reached 97% with joint use of both models, but sensitivity decreased to 72%. Conclusions: presence or absence of cirrhosis in patients with silent liver disease can be established by Doppler ultrasound with high diagnostic accuracy. The joint use of both scores has high diagnostic specificity. Both diagnostic models are highly reproducible(AU)
