Occult cirrhosis diagnosed by transient elastography is a frequent and under‐monitored clinical entity
Bibliographic record
Abstract
BACKGROUND & AIMS: Diagnosis of preclinical compensated cirrhosis (occult cirrhosis, OC) is challenging due to lack of clinical findings. We evaluated prevalence and outcomes of OC by transient elastography (TE, Fibroscan(®)). METHODS: Eight hundred and seventy-one patients with compensated chronic liver disease (CLD) and TE examination were divided into: (i) OC (TE ≥ 13 kPa and no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (ii) clinically evident cirrhosis (TE ≥ 13 kPa with signs of cirrhosis); (iii) non-cirrhotic CLD (TE < 13 kPa). Outcomes included hepatocellular carcinoma (HCC), esophageal varices and ascites. Late diagnosis of outcomes was defined as HCC stage ≥intermediate by BCLC or variceal bleeding. RESULTS: Occult cirrhosis represented 12% of the cohort and 37% of cirrhotic patients. Independent predictors of OC were age [odds ratio (OR) 1.15; 95% confidence interval (CI), 1.04-1.26], HIV co-infection (OR 3.53; 95% CI, 1.85-6.76) and APRI (OR 2.63; 95 CI, 1.87-3.71). During a median follow-up of 24 (interquartile range 20-37) months, OC received less surveillance than clinically evident cirrhosis, with fewer ultrasounds (2.7 ± 1.5 vs 3.6 ± 2; P < 0.001) and gastroscopies (2 ± 0.8 vs 2.6 ± 1.4; P < 0.001). Incidence of outcomes was 3.5/100 per person-years (PY) (95% CI, 0.1-6.9) in OC, 0 in non-cirrhotic CLD and 9.8/100 PY (95% CI, 0.3-19.3) in clinically evident cirrhosis (P < 0.001). Late diagnosis occurred more in OC than clinically evident cirrhosis (60 vs 15%, P = 0.01). CONCLUSIONS: Occult cirrhosis is a frequent and under-monitored clinical entity associated with short-term risk of outcomes. TE may help early diagnosis, prompt initiation of surveillance and specific therapy for an otherwise unrecognized condition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".