Uncomplicated cirrhosis
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Tests at diagnosis
Fasting laboratory tests
- FBC
- AST
- ALT
- GGT
- Alkaline phosphatase
- PT
- Total bilirubin
- Serum albumin
- Serum protein electrophoresis (if suggestive context)if neededTo request if looking for a beta-gamma bridge (cirrhosis), hypergammaglobulinaemia (autoimmune hepatitis) or, if in doubt, alpha-1-antitrypsin deficiency: HAS lists electrophoresis among the serum tests of the specialist consultation [1]. Serum albumin, measured separately, stays on the prescription (calculation of the Child-Pugh score) [1].
- Fasting plasma glucose
- Lipid profile
- Alpha-fetoprotein
- Serum ferritin
- Transferrin saturation
- Hepatitis C serology
- Hepatitis B serology (HBsAg, anti-HBs antibodies, anti-HBc antibodies)
- Hepatitis A serology, IgG (if patient not vaccinated against hepatitis A)if neededAdult cirrhotic patient not vaccinated against hepatitis A: the vaccination schedule recommends vaccinating people with chronic liver disease and, in adults, doing a serology beforehand (instruction given in the schedule's chapter on vaccine supply shortages) [2]. For hepatitis B, the anti-HBs and anti-HBc antibodies on the prescription already serve to decide on vaccination [2].
- HIV serologyif neededPositive HBV or HCV serology; or risk factor for exposure, even if HBV and HCV serology are negative.
- HBV DNA (if HBsAg positive)if neededPositive HBsAg: HAS recommends testing for viral DNA [1].
- Hepatitis D serology (if HBsAg positive)if neededChronic carrier of HBsAg [1]; the NABM limits it to HBsAg carriers [3].
- HCV RNA (if anti-HCV antibodies positive)if neededPositive HCV serology: test for viral RNA [1]; NABM indication: demonstration of viral replication in case of positive serology [3].
Do not order
- Blood fibrosis scores (FibroTest, FibroMètre, Hepascore): reimbursed only for assessing untreated chronic hepatitis C without comorbidity, outside an obvious diagnosis of cirrhosis [3].
Twice-yearly tests
Laboratory tests
- Alpha-fetoprotein
- Total bilirubinif needednon-French guidelineCompensated cirrhosis followed by the MELD score: NICE has it calculated every 6 months and takes a score ≥ 12 as a sign of high risk of complications [6]; a US family medicine review repeats FBC, electrolytes and creatinine, liver function tests and PT/INR at the same interval to recalculate the Child-Pugh and MELD scores, and refers to a transplant centre from a MELD of 15 [5]. HAS (2008) provides for these tests once a year, in the minimum work-up [7]. In the absence of a vitamin K antagonist, the laboratory reports PT and, where appropriate, INR (code 0126) [3].
- Serum creatinineif needednon-French guidelineCompensated cirrhosis followed by the MELD score: NICE has it calculated every 6 months and takes a score ≥ 12 as a sign of high risk of complications [6]; a US family medicine review repeats FBC, electrolytes and creatinine, liver function tests and PT/INR at the same interval to recalculate the Child-Pugh and MELD scores, and refers to a transplant centre from a MELD of 15 [5]. HAS (2008) provides for these tests once a year, in the minimum work-up [7]. In the absence of a vitamin K antagonist, the laboratory reports PT and, where appropriate, INR (code 0126) [3].
- PT with INRif needednon-French guidelineCompensated cirrhosis followed by the MELD score: NICE has it calculated every 6 months and takes a score ≥ 12 as a sign of high risk of complications [6]; a US family medicine review repeats FBC, electrolytes and creatinine, liver function tests and PT/INR at the same interval to recalculate the Child-Pugh and MELD scores, and refers to a transplant centre from a MELD of 15 [5]. HAS (2008) provides for these tests once a year, in the minimum work-up [7]. In the absence of a vitamin K antagonist, the laboratory reports PT and, where appropriate, INR (code 0126) [3].
- Six-monthly liver ultrasound (not a laboratory test, to be prescribed in parallel)
Do not order
- PIVKA-II (DCP), AFP-L3, GALAD score or other blood biomarker of hepatocellular carcinoma: not recommended routinely for screening, apart from AFP [9].
Annual tests
Fasting laboratory tests
- AST
- ALT
- GGT
- PT
- Albumin
- Total bilirubin
- FBC
- Fasting plasma glucose
- Serum creatinine with eGFR
- Alpha-fetoprotein
Sources (11)
- Critères diagnostiques et bilan initial de la cirrhose non compliquée
- Ministère chargé de la santé. Calendrier des vaccinations et recommandations vaccinales 2026 (juillet 2026) : chapitres 2.8 (hépatite A), 2.9 (hépatite B) et 3.2 (tension d'approvisionnement, vaccin contre l'hépatite A).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : scores de fibrose hépatique (actes 1000 à 1002), alpha-fœtoprotéine (0320), ARN du VHC (4124), ADN du VHB (4120), anticorps anti-VHD (1740).
- Pache I. Prise en charge de la cirrhose par le praticien. Rev Med Suisse 2011;7(279):235-6.
- Smith A, Baumgartner K, Bositis C. Cirrhosis: Diagnosis and Management. Am Fam Physician 2019;100(12):759-770.
- National Institute for Health and Care Excellence. Cirrhosis in over 16s: assessment and management. NICE guideline NG50, juillet 2016, mise à jour en septembre 2023 : chapitres Diagnosis et Monitoring (recommandations 1.1 à 1.4).
- Surveillance des malades atteints de cirrhose non compliquée et prévention primaire des complications
- Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922-1965.
- Association française pour l'étude du foie (AFEF). Prise en charge du carcinome hépatocellulaire et outils pour la pratique. Recommandations, février 2025 : dépistage, questions 2 à 6.
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Diagnostik und Therapie des Hepatozellulären Karzinoms und biliärer Karzinome, Langversion 5.2, juin 2025 (AWMF 032-053OL) : recommandations 3.11 à 3.14 (Früherkennung).
- Association française pour l'étude du foie (AFEF). Recommandations pour le diagnostic et le suivi non invasif des maladies chroniques du foie. Juillet 2020.