Monitoring
Patients with cirrhosis should be monitored every 6-12 months with laboratory tests (renal function/electrolytes, liver function tests, albumin, full blood count, prothrombin time, alpha-fetoprotein) and imaging studies (6 monthly abdominal ultrasound) to check for:
Signs and symptoms of advanced liver disease
Disease progression
Development of complications of portal hypertension such as ascites, hepatic encephalopathy, jaundice, and variceal bleeding.
Screening for hepatocellular carcinoma (HCC) in patients with cirrhosis is reported to be of high value, enabling early detection and treatment, and improving chances of survival.[200] All patients with cirrhosis, especially those with viral hepatitis (type B and C), alcohol-related liver disease, and haemochromatosis, are at high risk of developing hepatocellular carcinoma and should undergo surveillance with ultrasound, with or without alpha-fetoprotein, every 6 months.[170] In clinical practice, computed tomography (CT) is used as a second-line diagnostic imaging modality. However, it may lack accuracy in ruling out HCC; one meta-analysis found that if CT is used in the detection of HCC of any size and stage, 22.5% of people with HCC would be missed, and 8.7% of people without HCC would be unnecessarily treated. However, all included studies were judged to be at high risk of bias, limiting the authors’ ability to confidently draw conclusions based on these results.[201] In another network meta-analysis, the multi-target HCC blood test was found to have higher sensitivity than ultrasound examination for early-stage detection; the sensitivity was comparable with ultrasound plus alpha-fetoprotein test combination.[202]
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