Diagnostic Performance of Liver Enzymes for Predicting Liver Cirrhosis in Sierra Leone

Abstract Background Cirrhosis is one of the major complications of chronic liver disease and a leading cause of death worldwide. Early detection is important to improve patient health. In resource-constrained countries such as Sierra Leone, the gold standards, liver biopsy and ultrasound, are hindered by cost, technical know-how, and infrastructural challenges. Routine liver enzyme tests may serve as alternatives for predicting liver cirrhosis. This study was done to evaluate the diagnostic importance of liver enzyme measurements, when combined with Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) scores, in predicting cirrhosis among patients in Sierra Leone. Methods We conducted a prospective diagnostic study involving 112 patients who were clinically suspected of having liver cirrhosis. Fresh serum samples were collected from each participant and processed within six hours using spectrophotometric assays to measure liver enzymes activity. Demographic and clinical information were compiled in Microsoft Excel, while statistical analyses were performed with Epi Info software. Descriptive statistics were used to summarize patient characteristics. Correlation tests and regression models were used to explore the relationship between enzyme levels and cirrhosis severity, focusing on associations with APRI and FIB-4 scores. Results The study population had a mean age of 35.7 years, with a gender distribution of 50.9% female and 49.1 % male . Median APRI and FIB-4 scores were 0.37 and 0.97, respectively, corresponding to cirrhosis prevalence of 7.2% and 5.4%. Elevated ALT levels were strongly associated with cirrhosis [aOR 12.1, 95% CI 1.9-63.0; p = 0.003], as were elevated AST levels [aOR 16.1, 95% CI 3.2-80.8; p = 0.001]. These associations highlight the significance of routine enzyme tests in identifying cirrhosis markers within this patient group. Conclusions This study shows that routine liver enzyme assays, especially ALT and AST, together with APRI and FIB-4 scores, can serve as useful diagnostic markers for cirrhosis in Sierra Leone. These tests are more cost-effective than biopsy and imaging in resource-limited settings. Future studies can be carried out to confirm their significance and guide future clinical management strategies.