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World J Gastroenterol. Mar 14, 2014; 20(10): 2613-2623
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2613
Non-invasive prediction of forthcoming cirrhosis-related complications
Wonseok Kang, Seung Up Kim, Sang Hoon Ahn
Wonseok Kang, Seung Up Kim, Sang Hoon Ahn, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Wonseok Kang, Seung Up Kim, Sang Hoon Ahn, Liver Cirrhosis Clinical Research Center, Seoul 120-752, South Korea
Author contributions: Kang W and Kim SU contributed equally to this work; Kang W and Kim SU contributed to the concept and design of the study, literature search, analysis and interpretation of data and drafting of the manuscript; Ahn SH contributed to the concept and design of the study, drafting of the manuscript, obtained funding and supervised the study.
Supported by The Liver Cirrhosis Clinical Research Center, a grant from the Korea Healthcare Technology RandD Project, Ministry of Health and Welfare, South Korea, No. HI10C2020; the Bilateral International Collaborative RandD Program from the Ministry of Knowledge Economy, South Korea
Correspondence to: Sang Hoon Ahn, MD, PhD, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. ahnsh@yuhs.ac
Telephone: +82-2-22281936 Fax: +82-2-3936884
Received: November 8, 2013
Revised: January 4, 2014
Accepted: February 17, 2014
Published online: March 14, 2014
Abstract

In patients with chronic liver diseases, identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies, assessing therapeutic response, and stratifying long-term prognosis. Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases, several non-invasive methods have been developed as alternatives to liver biopsies. Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard. However, non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker. Accordingly, recent studies have focused on assessing the performance of non-invasive methods through long-term, longitudinal, follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis. As a result, current view is that these alternative methods can independently predict future cirrhosis-related complications, such as hepatic decompensation, liver failure, hepatocellular carcinoma, or liver-related death. The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events. In this article, we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.

Keywords: Non-invasive model, Prediction, Cirrhosis, Complication, Liver-related events

Core tip: In this article, we summarized recent longitudinal studies of non-invasive methods - including transient elastography, European Liver Fibrosis scoring system, Fibrotest, and acoustic radiation force impulse technique - for predicting forthcoming complications related to liver cirrhosis. We also discussed the clinical value of currently available non-invasive methods based on evidence from the literature and finally proposed areas for future research directions.