Raynard et al identified risk factors for significant fibrosis in a patient with alochol-induced liver disease. These can help to identify a patient who may benefit from more aggressive management. The authors are from Hopital Antoine Beclere and Hopital Bicetre in France.
Patient selection: alcohol-induced liver disease
Alcohol consumption in the past 5 years: 110 grams per day (about 7.8 standard drinks)
Duration: 20 years or more (mean 25 years for those with significant fibrosis)
Outcome: fibrosis score > 2 (on a scale from 0 to 8)
Risk factors for fibrosis (with cutoffs based on data in Table 1):
(1) age >= 55 years
(2) female gender
(3) body mass index >= 24 kg per square meter
(4) glucose >= 5.6 mmol/L
(5) Perls grade of iron staining > 1 (range 0 to 3)
total number of risk factors =
= SUM(number of risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number: 5
• The risk for fibrosis should increase with the number of risk factors present.
Being able to predict significant fibrosis without a liver biopsy can be based on the first 4 risk factors. The iron stain result requires a liver biopsy in which case the fibrosis can be seen directly.
