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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Oct 28, 2014; 20(40): 14626-14641
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14626
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14626
Table 1 Diagnosis of confirmed advanced fibrosis/cirrhosis (F3-4) (histology, elastography) by conventional clinical parameters (ultrasound, laboratory) from Salem Medical Center (n = 364)
Parameter | Pathologic | F0-2 elevated | F3-4 normal |
Bilirubin | > 1.3 mg/dL | 7.6% | 58.3% |
INR | > 1.27 | 1.2% | 74.8% |
Platelets | < 150 /nL | 18.5% | 49.6% |
Spleen size | > 11.5 cm | 6.4% | 70.4% |
Signs of liver cirrhosis | > 0 | 1.6% | 59.1% |
Bilirubin, INR, signs of liver cirrhosis | > 0 | 10.0% | 43.5% |
Bilirubin, INR, platelets, spleen size, signs of liver cirrhosis | > 0 | 27.7% | 22.6% |
Table 2 Fibrosis stages of alcoholic liver disease patients undergoing alcohol detoxication as determined by liver biopsy n (%)
Fibrosis stage | Histology | TE | All |
F0 | 5 | 162 | 167 (45.9) |
F1-2 | 46 | 36 | 82 (22.5) |
F3 | 17 | 26 | 43 (11.8) |
F4 | 21 | 51 | 72 (19.8) |
Total | 89 | 275 | 364 |
Table 3 Relative distribution of histological features in alcoholic liver disease patients
Kleiner score (range) | Considered elevated | Percentage |
Kleiner steatosis 0-3 | > 1 | 69.4% |
Lobular inflammation 0-3 | > 1 | 38.8% |
Portal inflammation 0-1 | > 0 | 15.3% |
Ballooning 0-2 | > 1 | 15.3% |
Megamitochondria 0-1 | > 0 | 1.6% |
Mallory hyaline 0-1 | > 0 | 25.9% |
Classification steatohepatitis 0-2 | > 0 | 75.3% |
Table 4 Typical routine blood tests in alcoholic liver disease
Parameter | Pathologic | F0-2(<8 kPa) | F3-4(>8 kPA) | Mean F0-2 | Mean F3-4 |
GOT (U/L) | > 50 | 56.9% | 78.4% | 89.5 | 135.4 |
GPT (U/L) | > 50 | 50.6% | 48.6% | 75.0 | 70.6 |
GGT (U/L) | > 60 | 69.4% | 97.3% | 238.8 | 792.8 |
AP (U/L) | > 130 | 9.0% | 50.5% | 90.2 | 152.0 |
Bilirubin total (mg/dL) | > 1.3 | 7.8% | 43.2% | 0.8 | 2.9 |
INR | > 1.27 | 0.8% | 25.9% | 1.2 | 1.1 |
Platelets (/nL) | < 150 | 17.5% | 48.6% | 222.5 | 172.0 |
Ferritin (ng/mL) | > 1000 | 15.6% | 35.4% | 524.7 | 830.7 |
Ferritin (ng/mL) | > 400 | 39.8% | 60.4% | 524.7 | 830.7 |
Triglycerides (mg/dL) | > 200 | 29.4% | 25.7% | 187.9 | 206.5 |
Cholesterine (mg/dL) | > 200 | 65.5% | 52.8% | 225.7 | 202.8 |
Albumin (g/dL) | < 3.8 | 4.3% | 37.3% | 5.4 | 5.2 |
Transferrin (g/A) | < 2 | 14.8% | 38.6% | 2.5 | 2.2 |
Transferrin saturation | > 45% | 32.0% | 45.9% | 42.0 | 48.0 |
Hepatic steatosis (US) | > 1 | 70.9% | 82.4% | 1.9 | 2.2 |
Spleen size (cm) | > 11.5 | 7.5% | 35.5% | 9.6 | 11.1 |
Ascites | > 0 | 0.0% | 20.7% | 0.0 | 0.2 |
Signs of cirrhosis (US) | > 0 | 1.7% | 43.9% | 0.0 | 0.4 |
Liver stiffness (final) | > 8 | 0.0% | 100.0% | 4.8 | 32.7 |
CAP (dB/m) | > 300 | 42.2% | 64.9% | 287.0 | 308.3 |
Table 5 Serum fibrosis markers in alcoholic liver disease
Serum marker | n | Outcome | Ref. |
PIIINP | 44 | Correlation of PIIINP with fibrosis, but not inflammation or steatosis; PIIINP also positively correlated with ALP and GGT | Gabrielli et al[106], 1989 |
ApoA1 | 482 | Correlation with fibrosis (r = -0.70; P ≤ 0.001) | Bedossa et al[107], 1989 |
PGA (GGT PT ApoA1) PT | 624 | AUROC not significant | Poynard et al[108], 1991 |
PIIINP, Laminin | 44 | PIIINP, PIIINP-Fab and laminin measured by RIA were 21 ± 19 μg/L, 90 ± 42 μg/L and 2.5 ± 0.8 U/mL in alcoholic cirrhosis | Lotterer et al[109], 1992 |
PIIINP Type I col | 69 | Correlation PIIINP and score of alcoholic hepatitis (r = 0.60, P ≤ 0.0001) Correlation type I collagen and fibrosis score (r = 0.34, P ≤ 0.001) | Trinchet et al[110], 1992 |
TIMP1, PIIINP | 44 | Correlation TIMP1 and fibrosis (r = 0.70, P < 0.001 AUROC 0.96 ± 0.03) | Li et al[111], 1994 |
CDT | 74 | Sensitivity of CDT for alcohol consumption 57% with 100% specificity | Seitz et al[112], 1995 |
HA, PIIINP | 45 | AUROC for PIIINP 0.867 ± 0.054 | Pares et al[55], 1996 |
7S-IV col, TH-IV col, Laminin, TIMP | 58 | TH-IV concentration as best marker to distinguish ALD from non-ALD; good correlation between hepatic type V collagen and serum TH-IV, but not 7S-IV collagen; TIMP, may be useful in evaluating the degree of hepatic fibrosis | Tsutsumi et al[113], 1996 |
HA PT | 160 | Accuracy for cirrhosis diagnosis from 89.5% to 95% | Oberti et al[114], 1997 |
YKL-40 | 20 | YKL-40 was significantly increased in patients with alcoholic cirrhosis (median, 523 μg/L; P < 0.001) | Johansen et al[115], 1997 |
YKL-40, HA, PGA, Tran index | 146 | Threshold of 330 μg/L gave sensitivity of 50.8% with specificity 88.5% Correlation HA and prothrombin index | Tran et al[116,117], 2000 |
HA | 70 | Significant correlation (P < 0.01) between HA and albumin, platelets and bilirubin, but not with ALT | Plevris et al[118], 2000 |
TPS | 77 | TPS correlated significantly with liver cell necrosis and Mallory's hyaline degeneration | González-Quintela et al[119], 2000 |
Laminin Type-IV col | 80 | Cut-off for Laminin 4.1 UI/mL gave 90% sensitivity, 77% specificity, cut-off for CIV 150 ng/mL gave 89% sensitivity 77% specificity | Castera et al[120], 2000 |
Type-VI col | 61 | CVI and CXIV as sensitive marker in fibrosis progression in alcoholics | Stickel et al[121], 2001 |
Type-XIV col | 13 | ||
PT | 243 | Correlation PT and fibrosis score; r = -0.70, P < 0.0001 | Croquet et al[122], 2002 |
YKL-40, PIIINP | 370 | Serum levels of YKL-40 and PIIINP are elevated in alcoholic patients; related to fibrosis | Nøjgaard et al[123], 2003 |
HA | 87 | Correlation HA and histological stage of ALD (r = 0.54, P < 0.0001); AUROC for HA and fibrosis 0.76 | Stickel et al[124], 2003 |
ELF panel | 64 | AUROC 0.94 ± 0.056 | Rosenberg et al[125], 2004 |
Table 6 Liver stiffness and fibrosis stages in alcoholic liver disease (biopsy proven studies)
Table 7 Histological scores for alcoholic hepatitis
Ref. | Score | n | AUROC | Day survival | Histological parameters | INR | Bilirubin | Age | Albumin | Urea | Leuko | MELD | DF |
Forrest et al[15], 2005 | GAHS | 241/195 (137) | 0.65-0.71 | 28 and 84 d | Steatohepatitis | - | 9 | - | - | - | - | - | 41 |
Mookerjee et al[129], 2011 | ASH Grade | 68 | 0.80 | - | Fibrosis Cholestasis Cholangiolitis Steatosis Ballooning Steatosis | 1.7 | 13.3 | 51 | 25 | 13.5 | 13.3 | 12.5 | 38 |
Affò et al[130], 2013 | ASH score | 121+205 | 0.74 | 90 d | Fibrosis Bilirubinostasis Megamitochondria PMN infiltration | 1.6 | 9.7 | 49 | - | - | - | 18 | - |
Table 8 Clinical scores and alcoholic hepatitis
- Citation: Mueller S, Seitz HK, Rausch V. Non-invasive diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20(40): 14626-14641
- URL: https://www.wjgnet.com/1007-9327/full/v20/i40/14626.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i40.14626