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

Table 7 Diagnostic performance of non invasive markers of liver fibrosis in detecting cirrhosis

Marker	Disease	Sensitivity	Specificity	AUC	References
Direct markers of liver fibrosis
Hyaluronic acid	HCV	80-100	79-89.4	0.85-0.92	[61,63] [71,74]
	AFLD	99	80	0.93	[66]
	NAFLD	n.a.	n.a.	0.92	[65]
YKL-40	HCV	80	71	0.79	[71]
Type IV collagen	HCV	60	61	n.a.	[71,73]
Procollagen III	HCV	60-77	66-74	0.73	[71,74]
MMP-2	HCV	74-83	96-100	0.97	[75]
TIMP-1	HCV	100	56-75	0.9	[75]
Indirect markers of liver fibrosis
AAR	HCV	47-81.3	55.3-97		[85,102] [96]
	HIV/HCV	38	77	0.6	[87]
APRI	HCV	38.4-57	86.7-93	0.61-0.94	[86,95-97]
	HIV/HCV	53	89	0.79	[87]
GUCI	HCV	80	78	0.85	[89]
Fibrotest	HCV	13-50	91-98	0.71-0.87	[90,97]
					[100,101]
	HIV/HCV	100	65	0.87	[91]
	HBV	18	99	0.78	[92]
	AFLD	99	83	0.95	[66]
Glycocirrho test	Most HCV	79	86	0.87	[94]

AUC = area under the curve; AFLD = alcoholic fatty liver disease; NAFLD = non-alcoholic fatty liver disease; YKL-40 = human cartilage glycoprotein-39; MMP-2 = metalloproteinase 2; TIMP-1 = tissue inhibitor metalloproteinase 1; AAR = aspartate to alanine aminotrasferase ratio; APRI = AST to platelet ratio index; GUCI = Goteborg University Cirrhosis Index.