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Cirrhosis represents the end stage of chronic liver disease, characterized by high mortality and morbidity. The prevalence of liver disease is difficult to assess, given its clinical latency up to the late stage.We aimed to assess the prevalence of unrecognized chronic liver disease and cirrhosis using surrogate indicators from medical records of family physicians.Medical records of 139,104 subjects, collected from 99 family physicians of the Veneto region, were used. Persistently high transaminases were used as indicators of occult chronic liver disease; thrombocytopenia, unrelated to haematological malignancies, was used as indicator of occult cirrhosis. Diagnosis of chronic liver disease and cirrhosis was assessed using ICD9-CM-1997 codes.Alteration of transaminases was found in 32.7% of the subjects, and among them only one-third had an already diagnosed liver disease. Patients with diagnosis of cirrhosis were 0.3%, while thrombocytopenia, indicator of occult cirrhosis, was detected in 1.3% of the remaining population. Patients with overt and occult cirrhosis showed a higher metabolic profile, with significantly higher prevalence of arterial hypertension, obesity and diabetes than the general population.A large proportion of patients with chronic liver disease is still undiagnosed. Surrogate biochemical indicators might be useful for disease recognition.

Background and Aim: Liver cirrhosis is characterized by high morbidity and mortality rates. This study was addressed to evaluate the epidemiological and economic impact of cirrhosis on hospitalizations in a large population in Italy. Methods: Epidemiological analysis was performed using hospital discharge sheets of 57,720 hospitalizations due to liver disease from 2006 to 2008, selected from the Veneto regional archive. In a sample of 100 randomly selected hospitalizations, a detailed cost analysis was performed and a comparison was made with sets of patients admitted for heart failure (HF) and chronic obstructive pulmonary disease (COPD). Results: Among patients with cirrhosis, ascites emerged as the most frequent cause of admission, followed by hepatic encephalopathy, hepatocellular carcinoma, and upper gastrointestinal bleeding. Encephalopathy and ascites were the complications with the highest rates of readmission. The detailed cost analysis of hospitalizations revealed that economic expenses in the set of patients admitted for cirrhosis were about 30% higher than those for patients admitted for HF or COPD, mainly due to the longer duration of hospitalization. Conclusions: Cirrhosis has a relevant epidemiological and economic impact on hospitalizations and preventive strategies for its clinical management are warranted.

Background & Aims: A slowed electroencephalogram (EEG) is indicative ofthe presence of hepatic encephalopathy (HE). Since HE is not reflected in theMELD score and is an important prognostic parameter, we assess the prog-nostic benefit of the addition of an EEG-based HE index to theMELD. Methods: Three hundred and ninety-two patients with cirrhosisunderwent EEG and automated determination of its mean dominant fre-quency (MDF). MELD was calculated at the time of EEG recording. Patientswere monitored for up to 18 months in relation to the occurrence of death/transplantation. The prognostic value of the stand-alone/combined MELDand MDF was calculated using standard survival analysis techniques. Patientstransplanted for hepatic decompensation were considered dead on the day oftransplantation, those transplanted for hepatocellular carcinoma were cen-sored. The findings were validated using a split-sample technique (referencegroup: n = 256; test group: n = 136). During the follow-up period, 107patients died/were transplanted for hepatic decompensation. Results: BothMELD and MDF predicted mortality on Kaplan–Meier analysis, and bothwere independent predictors of mortality on a Cox model. Based on Coxregression parameters, a novel prognostic index was devised, as follows:MELD-EEG = 0.087*MELD–0.306*MDF. On ROC curve analysis, MELD-EEG had higher prognostic accuracy in predicting 12- and 18-month mortal-ity compared to MELD (P = 0.016 and P = 0.018, respectively). In addition,it had better sensitivity and reduced the misclassification rate for given levelsof specificity. On validation, no significant differences were observed betweenthe reference/test groups. Conclusions: The addition of an automaticallyobtained EEG-based index improves the prognostic accuracy of the MELDscore.Hepatic encephalopathy (HE) is not part of the MELDscore, which is widely used to assess the severity of hepa-tic failure and to estimate the need/timing for hepatictransplantation (1, 2). This is mostly related to difficul-ties and interoperator variability in the clinical diagnosisof HE, and its grading (3). In addition, while part of theChild-Pugh score (4), overt HE did not seem to signifi-cantly improve the prognostic accuracy of MELD whenthis was originally devised (1). However, there is evi-dence that HE is a good prognostic marker of survivalin patients with cirrhosis (5–7). HE has also been shownto carry prognostic information which is additive to thatof MELD, and it has been suggested that patients withHE may not receive a transplant in a timely fashion ifMELD is used as a stand-alone (8). In recent years, toolshave become available to quantify HE across its spec-trum of severity in a non-operator dependent, docu-mentable fashion, thus providing ‘MELD-like’ summaryHE indices. These tools include the automated assess-ment of the electroencephalographic (EEG) slowingwhich characterizes HE (Fig. 1) (9, 10). This has beenshown to have a good relationship with laboratorymarkers of HE (11), a history of HE/its developmentover time (12), and survival, especially in patients withmoderate/severe hepatic decompensation (6, 8).The prognostic efficiency of MELD can probably beimproved, especially in patients with non-fulminanthepatic failure (13, 14). A number of proposals have