PTU-117 Cutaneous Stigmata Of Chronic Liver Disease; What Do They Mean?

Abstract

Introduction As clinicians we are taught to assess all patients for cutaneous signs of chronic liver disease (CLD). However, there is limited evidence available in the literature regarding their significance or prognostic value for diagnosing the presence or severity of CLD. The aim of this prospective study, therefore, was to assess the frequency and significance of cutaneous stigmata in patients with suspected CLD. Methods Between 2006 and 2011 outpatients with suspected CLD attending for liver biopsy were assessed by an experienced gastroenterology registrar, who undertook the liver biopsy, and documented the presence of palmar erythema, Dupuytren's contracture, spider naevi, clubbing or gynaecomastia. Correlation between these cutaneous stigmata and the presence and degree of liver damage was assessed by the chi square test. Results 124 consecutive outpatients underwent assessment and liver biopsy; 42 (34%) female and 82 (66%) male, median age 46 years (range 18-78). Bloods tests showed median bilirubin 11 mumol/l (range 3-500), median ALT 74 IU/l (range 11-562) and median INR 1 (range 0.8-1.7). The commonest clinicopathological diagnoses were chronic hepatitis C 31%, non-alcohol related fatty liver disease 19% and alcohol related liver disease 12%. 19 patients had cirrhosis, 56 fibrosis and 49 had no fibrosis. Overall only 36/124 (29%) patients had any stigmata of CLD. 13/19 cirrhotic patients had stigmata compared to 23/105 non cirrhotic patients (c 2 = 18.5, p < 0.001). 26/75 patients with any degree of fibrosis had stigmata compared to 10/49 patients with no fibrosis (c2 = 1.8, p = NS). 7 patients had 2 different stigmata of CLD, of whom 5 had cirrhosis and 2 had fibrosis. Females (14/42) were no more likely to have stigmata than males (25/82) (c 2 = 0.1, p = NS). Patients with viral hepatitis were no more likely to have stigmata than those with fatty liver disease (c 2 = 1, p=NS). Conclusion Cutaneous stigmata of CLD are absent in the majority of patients with suspected CLD and a significant minority of patients with cirrhosis. This may contribute to the under diagnosis of chronic liver disease at all stages of severity.