Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review

Table 2 Major advantages and limitations of noninvasive periportal fibrosis markers in Schistosomiasis mansoni infected patients

PFF markers	Advantages	Limitations
Direct markers
PICP	Elevated levels in patients not treated yet with praziquantel and related to the stage of fibrosis and necroinflammation	Not reliable for establishing fibrosis grade
P3NP	Use for complicated patients who developed hypertension and with more severe liver diseases	Low sensitivity in mild cases
Serum type VI collagen	Correlated with liver fibrosis, splenomegaly, portal vein dilatation and the presence of portosystemic collaterals	Low sensitivity
Hyaluronic acid	Marker for the initial phase of liver fibrosis and it is able to assess the severity of liver disease	High levels in different etiologies of liver disease, barely accessible
Indirect markers
APRI	Low cost, good sensitivity, high diagnostic accuracy for cirrhosis	Interference of hepatic comorbidities
Blood platelet count	Low cost and sensitive marker. It is a marker of portal hypertension and inversely correlated with advanced PPF and the diameter of the spleen	Interference of coagulopathies, some drugs and other live disorders
GGT	Low cost. Correlated with more advanced PPF, faster fibrosis progression rate and indicates intrahepatic alterations	Interference of hepatobiliary alterations
Coutinho Index	Simplicity of calculation and low cost	Requires more tests for use in mild and moderate fibrosis

HA: Hyaluronic acid; PICP: Procollagen type I carboxy-terminal peptide; P3NP: Procollagen type III amino-terminal peptide; PPF: Periportal fibrosis; APRI: Aspartate aminotransferase to platelet ratio index; GGT: Gamma glutamyl transferase.