Noninvasive investigations for non alcoholic fatty liver disease and liver fibrosis

Table 3 Serological markers for nonalcoholic steatohepatitis and fibrosis

Serological markers	Advantage	Disadvantage
C reactive protein[53]	Independent risk factor for progression of NAFLD	Lack of specificity for NASH
Plasma pentraxin 3[54]	Can differentiate between NASH and non progressive NAFLD	Lack of specificity for NASH
	Fibrosis marker in NAFLD
Hyaluronic acid[34]	Identify fibrosis at a cut-off value of 45 ng/mL	Cannot differentiate NASH from simple steatosis
Tissue inhibitor of metalloproteinases[34]	Fibrosis marker	Cannot differentiate NASH from simple steatosis
Cytokeratin 18[3]	Marker of hepatocyte apoptosis	Limited utility in clinical practice
	Independent predictor of NASH and severity of disease
Polypeptide specific antigen[57]	Marker in differentiating NASH from pure fatty liver	Marker for various cancers
Endothelin 1[59]	Can differentiate NASH from simple steatosis	Lack of specificity for NASH

NAFLD: Non-alcoholic fatty liver disease; NASH: Nonalcoholic steatohepatitis.