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Copyright ©2014 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 21, 2014; 20(11): 2854-2866
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2854
Table 1 Major advantages and limitations of liver biopsy and noninvasive fibrosis markers
Liver biopsyNoninvasive markers
Advantages
Validated scoring systemsAbsence of significant discomfort and risks
Differential diagnosis and associated conditionsAllows frequent re-evaluation
Simultaneous evaluation of necro-inflammationObjective interpretation
Patient acceptance
Limitations
InvasiveLow accuracy to discriminate between intermediate stages of fibrosis
High costNonspecific for the liver (biomarkers)
Sampling errors and intra- and inter-observer variabilityInfluence of several extra-hepatic factors
Table 2 Selected models including indirect markers of liver fibrosis
Score (original reference)VariablesPerformance in HCV patients1
Significant fibrosis (≥F2)
Cirrhosis (≥F4)
Median AUROCMedian sensitivity2Median specificity2Median AUROCMedian sensitivity2Median specificity2
APRI[24]AST and platelet count0.7781%95%0.8477%94%
FIB-43[41]Age, AST, ALT and platelet count0.7464%79%0.8790%92%
Forns index[48]Age, platelet count, cholesterol levels, and GGT0.7688%94%0.8798%91%
Fibro index[50]Platelet count, AST, and gamma globulin0.7694%97%0.8670%91%
Table 3 Most studied models combining direct and indirect biomarkers for the diagnosis of liver fibrosis in chronic hepatitis C
Score (original reference)VariablesPerformance in HCV patients1
Significant fibrosis (≥F2)
Cirrhosis (≥F4)
Median AUROCMedian sensitivity2Median specificity2Median AUROCMedian sensitivity2Median specificity2
FibroTest[53]Age, sex, serum haptoglobin, α2-macroglobulin, apolipoprotein A1, GGT, and total bilirubin0.7992%96%0.8685%81%
ELF[56]Age, TIMP-1, PIIINP and hyaluronic acid0.8185%70%0.88--
Fibrometer[61]Platelet count, prothrombin index, AST, α2-macroglobulin, hyaluronic acid, blood urea nitrogen and age0.8269%81%0.91--
FIBROspect II[63]TIMP-1, α2-macroglobulin and hyaluronic acid0.8680%70%---
Hepascore[66]Age, sex, α2-macroglobulin, hyaluronic acid, GGT and total bilirubin0.7966%79%0.8972%86%