Introduction Prognostication in cirrhotic liver disease is difficult. There are several validated indices which are employed including: Child-Pugh score, MELD and UKELD. There is anecdotal data that liver size is important in determining patient survival and likelihood of re-compensation.
Aims To assess a ratio of liver area and abdominal area on cross-sectional imaging using CT to predict the likelihood of death or need for liver transplantation (LT) in patients with liver cirrhosis.
Methods A retrospective analysis of 280 patients referred to the South West Liver Unit. All patients with cirrhosis were included who had liver CT available. Patients with acute liver failure or hepatoma were excluded from the analysis. Using a webpacs system patient imaging were retrieved and the cross sectional image with the largest area of liver was identified. The liver to abdomen area ration (LAAR) was estimated from the hypothesised ellipses represented by the liver and abdomen using the formula Πab (where ‘a’ being half of the long axis and ‘b’ being half of the short axis). These values were compared against patient survival vs patient death/LT. Accuracy of LAAR in predicting the outcome was assessed using Mann–Whitney U test.
Results 280 patients were identified. Sex was available in 200 patients (61% male). Aetiology was available in 266 patients: ALD=103, HCV=32, NASH=10, PBC=10, PSC=13, HCC=31, ALF=12, Others=51. HCC and ALF patients were excluded from analysis. The median age 54.2 (46.6–61.1). Ascites was present in 79 of 127 patients (62%). Not all patients had a CT. LAAR was calculated in 108 patients, median 0.37 (0.3–0.43) and was shown to be predictive of death/LT (p=0.035). The presence of ascites did not predict survival (χ2 2.5, p=0.12, OR 1.9 (95% CI 0.86 to 4.01)).
Conclusion LAAR is a simple, novel imaging based technique to assess prognosis in patients with cirrhosis. It confirms anecdotal data that liver size is important in assessing survival. It is more accurate in determining survival than the presence of ascites. LAAR could be incorporated into existing algorithms for patient selection for LT and in determining patient survival with cirrhosis. Its accuracy should be compared against Childs-Pugh, MELD and UKELD alone or in combination to evaluate its utility in clinical practice.
Competing interests None declared.
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