9% (4/44) of autopsied ICU patients had cirrhosis, three of these apparently unsuspected pre-mortem. Histological evaluation was only done in one case. The autopsy diagnosis of cirrhosis, particularly early cirrhosis, is not always straightforward with regard to confirmation or exclusion and histology also may indicate a cause for cirrhosis. Therefore more histological sampling would be useful. Unsuspected cirrhosis in a hospitalised patient population is an unquantified and complex problem. There is no simple non-invasive test that detects cirrhosis reliably, yet the presence of cirrhosis has significant impact on morbidity and mortality following major operations and in multi-organ disease as encountered in ICU patients 47.