Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy

Table 6 Diagnostic performance of non invasive markers of liver fibrosis in discriminating between no-mild fibrosis (F0-F1 by METAVIR) and moderate-advanced fibrosis (F ≥ 2 by METAVIR)

Marker	Disease	Sensitivity	Specificity	AUC	References
Direct markers of liver fibrosis
Hyaluronic acid	HCV	75-79	80-100	0.82-0.92	[61-62] [69,74]
	HBV	91	98.1	0.98	[68]
	AFLD	87	93	0.79-0.91	[64,66]
	NAFLD	66-85	68-91	0.78-0.87	[65,67] [72]
Laminin	HCV	80	83	0.82	[69,81]
	NAFLD	82	89	n.a.	[67]
YKL-40	AFLD	88.5	50.8	n.a.	[70]
	HCV	78	81	0.81	[71]
Type IV collagen	HCV	73-80	81-85	0.83	[69,73]
	NAFLD	64	89	n.a.	[67]
Type IV collagen-7s	HCV	74-83	75-88	n.a.	[73]
	NAFLD	70	81	0.83	[72]
Procollagen III	HCV	60-78	74-75	0.69	[71,74]
	AFLD	80	87	0.87	[64]
MMP-2	HCV	7-75	70-100	0.59	[62,75]
TIMP-1	HCV	67	68	0.71	[75]
Three marker panel	HCV	77	73	0.83	[76]
Indirect markers of liver fibrosis
APRI	HCV	41-91	47-95	0.69-0.88	[86,95-97]
	HIV/HCV	51	91	0.8	[87]
Forns’ index	HCV	79.8-94	95-98.3	0.78-0.86	[88,98] [99,97]
	HIV/HCV	43	96	0.77	[87]
Fibrotest	HCV	65-87	59-80.6	0.74-0.87	[90,97]
					[100,101]
	HIV/HCV	90	60	0.85	[91]
	HBV	34	93	0.78	[92]
	AFLD	88	60	0.84	[66]
FPI	HCV	85-96	94-98	0.77	[93]

AUC=area under the curve; AFLD=alcoholic fatty liver disease; NAFLD=non-alcoholic fatty liver disease; n.a.=not available; YKL-40=human cartilage glycoprotein-39; MMP-2=metalloproteinase 2; TIMP-1=tissue inhibitor metalloproteinase 1; APRI=AST to platelet ratio index; FPI= fibrosis probability index.