Importance of XXXX in @entity1577 and the predictive value of liver biopsy.

@entity1 @entity82 @entity101 @entity409 @entity1575 @entity493 @entity1577
@entity1575 ( @entity1575 ), which results from progressive hepatobiliary @entity82 , is an important cause of morbidity and mortality, but it is difficult to identify before @entity101 ( @entity101 ) ensues. Clinical signs, serum @entity493 aminotransferase (ALT) levels, and ultrasound (US) are widely applied, but their value in predicting the presence of @entity82 , the development of @entity101 , or adverse outcomes is undetermined. The potential gold standard, liver biopsy, is not standard practice and, notwithstanding sampling error considerations, has not been systematically evaluated. Forty @entity1 with @entity1577 (median age = 10.6 years) with abnormal clinical, biochemical, and US findings were subjected to dual-pass percutaneous liver biopsy. Clinical outcomes were recorded over 12 years of follow-up (median = 9.5 years for survivors). Logistic regression and receiver operating characteristic analyses were applied to predict @entity1575 (which was assessed by @entity82 staging and quantitative immunohistochemistry) and the occurrence of @entity101 . @entity101 occurred in 17 of 40 @entity1 (42%), including 6 of 7 (17%) who died during follow-up. Clinical examination, serum ALT levels, and US findings failed to predict either the presence of liver @entity82 or the development of @entity101 . @entity82 staging on liver biopsy, where the accuracy was improved by dual passes (P = 0.002, nonconcordance = 38%), predicted the development of @entity101 (P < 0.001), which occurred more frequently and at a younger age in those with severe @entity82 . CONCLUSION: Clinical modalities currently employed to evaluate suspected @entity1575 help to identify a cohort of @entity1 at risk for @entity409 and adverse outcomes but do not predict an individual's risk of liver @entity82 or @entity101 development. Liver @entity82 on biopsy predicts the development of clinically significant @entity409 . Dual passes help to address sampling concerns. Liver biopsy has a relevant role in the management of @entity1 with suspected @entity1575 and deserves more widespread application.
