Noninvasive Alternatives to Assess Liver Fibrosis: Ready for Prime Time?

William F. Balistreri, MD


December 02, 2014

In This Article

Serum Biomarkers

The practical advantages of emerging serum biomarkers include their high applicability and interlaboratory reproducibility, as well as their potential widespread availability. However, these biomarker panels require careful clinical correlation for critical interpretation of results. In addition, serum biomarkers often fail to discriminate adequately between lesser grades of fibrosis. Nevertheless, biomarkers are potentially useful monitoring and prognostic tools, with the ability to predict clinical outcome on the basis of repeated assessment of the ongoing pathophysiologic process of fibrogenesis.

The commonly used biomarkers for the detection of liver fibrosis include simple measures, such as the aspartate aminotransferase-to-platelet ratio index (APRI),[6,8] as well as several marketed products or validated algorithms that assess extracellular matrix turnover (fibrogenesis). These include:

  • FibroMeter™ (Echosens; Paris, France)[9];

  • FibroTest-ActiTest® (Biopredictive; Paris, France); HCV FibroSure® (LabCorp; Burlington, North Carolina)[10,11];

  • HepaScore[12] (also known as FibroScore);

  • Enhanced liver fibrosis (ELF) panel[13,14]; and

  • Fibrosis-4 (FIB-4) index.[15,16]

Each is derived from a panel of analytes that have been shown to predict the process or extent of fibrogenesis; please consult the cited references for specific details.

To varying degrees, these tests have achieved acceptance. Vergniol and colleagues[15] reported the value of several of these noninvasive tests in monitoring patients with chronic HCV infection and in predicting their outcome over a 3-year evolution of liver fibrosis. A meta-analysis by Xiao and colleagues[16] suggested that APRI and FIB-4 can identify hepatitis B virus (HBV)-related fibrosis with moderate sensitivity and accuracy.

The FibroTest was shown to correlate with survival and to have a similar 5-year prognostic value to that of liver biopsy in patients with a variety of liver diseases, such as chronic HBV or HCV and alcoholic liver disease.[17] Vallet-Pichard and colleagues[18] validated the simple, inexpensive FIB-4 index, which combines standard biochemical values (platelets, alanine aminotransferase [ALT], aspartate aminotransferase [AST]) and age, as an accurate method for assessing liver fibrosis, concordant with FibroTest results.


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