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COPYRIGHT 2003 American Academy of Family Physicians
Applying the Evidence: Richard is a 42-year-old man with chronic hepatitis C virus infection. He has no spider nevi, and laboratory test results are as follows: aspartate transaminase level, 32 U per L; g-glutamyltransferase level, 92 U per L; total cholesterol level, 250 mg per dL (6.45 mmol per L); and platelet count, 240 3 [10.sup.3] per [mm.sup.3] (240 3 [10.sup.9] per L). What is the probability that he has cirrhosis?
Answer: Referring to the accompanying table, Richard's risk of cirrhosis is only 1.8 percent. Applying his clinical data to equation 1 yields the following:
3.6 = 7.811-[3.131 3 In (240)] + [0.781 3 In (92)] + [3.467 3 In (42)]-[0.014 3 250].
Because the score is less than 4.2, Richard has a low likelihood of having cirrhosis.
Clinical Question
How likely is cirrhosis in a patient with hepatitis C?
Evidence Summary
Hepatitis C is a growing health concern. An estimated 3.9 million persons in the United States are infected with hepatitis C virus; 2.7 million of these persons have chronic infection. (1,2) Cirrhosis develops in approximately 7 percent of patients with chronic hepatitis C virus infection. (1,2) Patients with significant fibrosis are at higher risk for progression to cirrhosis and are candidates for antiviral therapy. Patients with cirrhosis may benefit from screening for hepatocellular cancer, although the actual benefit of screening remains unproved. (1)
Three clinical decision rules estimate the likelihood of fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. The estimated likelihood of these conditions can be a factor in deciding whether to order a liver biopsy and in prioritizing...
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