Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease.
OBJECTIVE
The aim of this study was to determine the diagnostic use of noninvasive markers of fibrosis in patients with chronic alcoholic liver disease.


METHODS
A total of 221 consecutive patients with an alcohol intake of >50 g/day (median, 100 g/day) and available liver biopsy examination and FibroTest FibroSure (FT) results were included prospectively. Fibrosis was assessed blindly on a 5-stage histologic scale similar to that of the METAVIR scoring system. Hyaluronic acid was measured and used as a standard serum marker of fibrosis.


RESULTS
Advanced fibrosis (F2-F4) was present at biopsy examination in 63% of patients. The mean FT value (SE) was F0 = .29 (.05); F1 = .29 (.03), F2 = .40 (.03), F3 = .53 (.04); and F4 = .88 (.02) (P < .05 between all groups, except between F0 and F1). As opposed to FT, there was no significant difference for hyaluronic acid between F2 and F1 and between F2 and F0. For F2-F4 vs. F0-F1, the FT area under the ROC curves (AUROC) = .84 (.03) and .79 (.03) for hyaluronic acid. For the diagnosis of F4, the AUROC was very high, .95 for FT and .93 for hyaluronic acid. The discordances of the 2 stages were attributed to biopsy failures in 26 cases and to FT failures in 13 cases.


CONCLUSIONS
In heavy drinkers, FT is a simple and noninvasive quantitative estimate of liver fibrosis. The use of FT may decrease the need for liver biopsy examination.
Naveau
Sylvie
S
Department of Hepato-Gastroenterology, Hôpital Antoine Béclère, Clamart, France.
Raynard
Bruno
B
Ratziu
Vlad
V
Abella
Annie
A
Imbert-Bismut
Françoise
F
Messous
Djamila
D
Beuzen
Fabienne
F
Capron
Frédérique
F
Thabut
Dominique
D
Munteanu
Mona
M
Chaput
Jean Claude
JC
Poynard
Thierry
T
D015415:Biomarkers / Q000097:blood*; D001707:Biopsy, Needle; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000401:mortality* / Q000473:pathology*; D008108:Liver Diseases, Alcoholic / Q000401:mortality* / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D015415:Biomarkers; D006820:Hyaluronic Acid