Potential role of noninvasive biomarkers during liver fibrosis

Table 1 Comparison of characteristics of invasive and non-invasive methods

No.	Feature	Invasive	Non-invasive
1	Invasiveness	Yes	No
2	Sampling error	Yes	No
3	Cost-effective	No	Yes
4	Patient-friendly	No	Yes
5	Hospitalization required	Yes	No

Table 2 Scoring systems for liver fibrosis

Stage	IASL	Batts-Ludwig	METAVIR
No fibrosis	No fibrosis	Stage 0	F0
Fibrosis portal expansion	Mild fibrosis	Stage 1	F1
Few bridges or septa	Moderate fibrosis	Stage 2	F2
Numerous bridges or septa	Severe fibrosis	Stage 3	F3
Cirrhosis	Cirrhosis	Stage 4	F4

IASL: International Association for the Study of the Liver.

Table 3 Correlation of transient elastography cutoffs with METAVIRscore

METAVIR score	Cutoff TE score (kPa)	Sensitivity	Specificity	NPV	PPV
F ≥ 2 (F0-F1 vs F2-4)	7.1	0.67	0.89	0.48	0.95
F ≥ 3 (F0-F1-F2 vs F3, 4)	9.5	0.73	0.91	0.81	0.87
F ≥ 4 (F0-F1-F2-F3 vs F4)	12.5	0.87	0.91	0.95	0.77

TE: Transient elastography; NPV: Negative predictive value; PPV: Positive predictive value.

Table 4 Sensitivity and specificity of non-invasive biomarkers in liver fibrosis

Marker	Parameters involved	Disease	AUROC for liver fibrosis	Sensitivity	Specificity	Ref.
AST/ALT ratio	AST and ALT	NAFLD; HCV	0.83; -	74; 47	78; 96	McPherson et al[87]; Park et al[88]
BARD score	BMI, AST, ALT, DM	NAFLD	0.76	74	66	Sun et al[89]
APRI	AST, platelet count	NAFLD	0.67	27	89	McPherson et al[87]
ALT	ALT	HCV	0.716-0.815	-	-	Pradat et al[59]
Forns index	Age, platelet count, GGT, cholesterol	HCV	0.81-0.86	94	51	Forns et al[60]
PGA and PGAA	Prothrombin time, GGT, apolipoprotein A1, α2 macroglobulin	Acute liver disease	0.84-0.86	-	-	Nguyen-Khac et al[90]
FIB-4	Platelet count, AST, ALT, age	HCV; NAFLD	0.74-0.77; 0.85	67; 84	71; 69	Sebastiani[23]; Sun et al[89]
Fibro test	Haptoglobin, apolipoprotein A1, α2 macroglobulin, GGT, bilirubin, age, and gender	HBV; HCV; ALD	0.84; 0.87; 0.83	61; 75; -	80; 85; -	Salkic et al[91]; Imbert-Bismut et al[66]; Naveau et al[62]
Hepascore	GGT, bilirubin, HA, α2 macroglobulin, age, and gender	HCV	0.82	-	-	Naveau et al[62], Adams et al[92]
SHASTA index	HA, AST, and albumin	HCV	0.87	50	94	Kelleher et al[93]
Fibrospect II	α2 macroglobulin, HA, and TIMP-1	HCV	0.82-0.83	77-83	66-73	Patel et al[94]

AUROC: Area under receiver operating curve; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; NAFLD: Non-alcoholic fatty liver disease; HBV: Hepatitis B virus; HCV: Hepatitis C virus; BMI: Body mass index; DM: Diabetes mellitus; APRI: Aspartate aminotransferase to platelet count ratio; FIB-4: Fibrosis-4; GGT: Gamma-glutamyltransferase; HA: Hyaluronic acid; TIMP-1: Tissue inhibitors of metalloproteinases-1.