Noninvasive markers of fibrosis: key concepts for improving accuracy in daily clinical practice
Journal Title: Annals of Hepatology - Year 2012, Vol 11, Issue 4
Abstract
Noninvasive markers of fibrosis have emerged as an alternative to the staging of fibrosis by means of liver biopsy. Apart from being noninvasive and thus lacking the adverse effects of liver biopsy, they offer some advantages such as reduced risk of sampling error, objectiveness in the interpretation of the result, appropriateness for repeated measurements and lower cost. Many studies have validated different panels of blood markers and imaging/transient elastography for the estimation of fibrosis with acceptable accuracy. Clinical scenarios leading to inacurate or failed estimation must be acknowledged, as well as the fact that performance of blood markers and transient elastography, and their diagnostic cut-off values vary among specific liver diseases. The combination of two blood markers or of a blood marker and transient elastography has been shown to increase accuracy of the estimation. Further, unlike liver biopsy the noninvasive markers of fibrosis are not associated with a ceiling effect after cirrhosis is identified, but can discriminate early from advanced stages of cirrhosis. Longitudinal studies have shown their utility as predictors of complications from portal hypertension and mortality, outperforming liver biopsy. In conclusion, noninvasive markers of fibrosis provide major advantages over liver biopsy. The reported performance of some of the available tests particularly when used in combination make them a reliable tool, very attractive for daily clinical practice.
Authors and Affiliations
Andrés Duarte-Rojo, José Altamirano, Jordan Feld
Keywords
Related Articles
- EP ID EP78160
- DOI -
- Views 103
- Downloads 0
Kupffer cells: increasingly significant role in nonalcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) is considered to be a manifestation of liver metabolic damage and is related to insulin resistance and genetic susceptibility. Inflammation mediated by Kupffer cells (KCs) is of...
Hemorrhagic liver cyst rupture: An unusual life-threatening complication of hepatic cyst and literature review
[b]Background & aims[/b]. Hemorrhagic rupture is an extremely rare complication of hepatic cyst. Its incidence, gravity and treatment modalities are inadequately covered in the literature. [b]Material and met...
Genetic susceptibility to hepatoxicity due to bosentan treatment in pulmonary hypertension
Background. Hepatotoxicity is a major side effect of treatment with bosentan in patients with pulmonary hypertension (PH). Bosentan is metabolized by the cytochrome CYP2C9 and inhibits the bile salt export pump, which is...
Re-treatment of previous non-responders and relapsers to interferon plus ribavirin with peginterferon alfa-2a (40KD), ribavirin ± amantadine in patients with chronic hepatitis C: randomized multicentre clinical trial
Introduction. A large number of patients with chronic hepatitis C have not been cured with interferon-based therapy. Therefore, we evaluated the efficacy of amantadine combined with the standard of care(pegylated interfe...
Is ursodeoxycholic acid detrimental in obstructive cholestasis? A propos of a case of malignant biliary obstruction
Ursodeoxycholic acid (UDCA) is the first choice medication for most cholestatic hepatopathies, due to its capability to counteract inflammation and bile-acid-induced liver damage, two common features in cholestasis. How...