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Table 1 Criteria used to assign the aetiology of the liver disease

From: Unexplained chronic liver disease in Ethiopia: a cross-sectional study

Aetiology Criteria used to assign diagnosis
1 Chronic hepatitis B infection Evidence of CLD on liver ultrasound and positive serum HBsAg.
2 Chronic hepatitis C infection Evidence of CLD on liver ultrasound and positive serum anti-HCV and positive HCV RNA.
3 Chronic hepatitis D infection Chronic hepatitis B infection and positive serum anti HDV IgG confirmed by detection of HDV RNA.
4 Primary biliary cholangitis i. Strongly positive anti-mitochondrial antibodies and
ii. Cholestatic liver function tests:
a. ALP > 1.5 x URR and
b. AST < 5 x URR
5 Autoimmune hepatitisa i. Strongly positive anti-nuclear antibodies or anti-actin and
ii. Elevated IgG > 1.1 x URR
6 Alcoholic liver disease i. Clinical and radiological signs of CLD and
ii. Daily alcohol consumption > 20 g/day in women and > 30 g/day in men for 6 months or more.
7 Non-alcoholic fatty liver disease i. Liver ultrasound findings of steatosis and
ii. Absence of significant alcohol consumptionb or other recognised secondary causes of steatosis and
iii. BMI > 25 kg/m2 c
8 Haemochromatosis i. Transferrin saturation > 50% and
ii. Genotyping showing C282Y homozygosity or C282Y/H63D heterozygosity or C282Y/S65C heterozygosity on the HFE gene.
9 Wilson’s disease i. Serum caeruloplasmin < 0.140 g/L and
ii. Age < 40 years
10 Alpha-1-antitrypsin deficiency Serum alpha-1-antitrypsin level < 0.85 g/L.
11 Malaria Positive malaria rapid diagnostic test and positive microscopy.
12 Hepatic schistosomiasis Presence of ova from Schistosoma mansoni in Kato-Katz thick stool smears and typical liver ultrasound findings viz. periportal thickening/‘pipestem’ fibrosis confirmed by an independent expert.
13 Visceral leishmaniasis Ultrasound findings of hepatosplenomegaly and
positive K39 antigen strip test confirmed by positive splenic smear.
14 Unexplained chronic liver disease None of the above
  1. Abbreviations: ALP alkaline phosphatase, anti-HCV hepatitis C virus antibody, anti-HDV hepatitis D virus antibody, AST aspartate aminotransferase, BMI body mass index, CLD chronic liver disease, HBsAg hepatitis B surface antigen, HCV hepatitis C virus, HDV hepatitis D virus, HFE high iron Fe, IgG immunoglobulin G, URR upper reference range
  2. Laboratory reference ranges: ALP (60–306 U/L); AST (14–40 U/L); IgG (0.8–27.8 g/L) [21]
  3. aBased on the American Association for the Study of Liver Disease (AASLD) simplified criteria [22] in the absence of histology
  4. bAlcohol consumption < 20 g/day in women and < 30 g/day in men
  5. cNot a part of the AASLD criteria [23] but adopted to exclude cases of starvation-induced steatosis