title: Non-invasive Diagnosis of Fibrosis in Non-alcoholic Fatty Liver Disease.
abstract: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed as well as in developing countries. Its prevalence continues to rise currently affecting approximately 20-30% of adults and 10% of children in the United States. Non-alcoholic fatty liver disease represents a wide spectrum of conditions ranging from fatty liver, which in general follows a benign non-progressive clinical course, to non-alcoholic steatohepatitis (NASH), a more serious form of NAFLD that may progress to cirrhosis and end-stage liver disease. Liver biopsy remains the gold standard for evaluating the degree of hepatic necroinflammation and fibrosis; however, several non-invasive investigations, such as serum biomarkers, have been developed to establish the diagnosis and also to evaluate treatment response. There has been a substantial development of non-invasive risk scores, biomarker panels, and radiological modalities to identify at risk patients with NAFLD without recourse to liver biopsy on a routine basis. Examples include combination of serum markers like NAFLD fibrosis score (NFS), BARD score, fibrometer, FIB4, and non-invasive tools like fibroscan which assess fibrosis in patients with NAFLD. Other markers of fibrosis that have been evaluated include high-sensitivity C-reactive protein, plasma pentraxin 3, interleukin-6, and cytokeratin-18. This review focuses on the methods currently available in daily clinical practice in hepatology and touches briefly on the potential future markers under investigation.
authors.affiliation: Departments of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
authors.affiliation: Departments of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
keywords: ALP, alkaline phosphatise; ALT, alanine aminotransferase; APRI, AST to platelet ratio index; AST, aspartate aminotransferase; AUCs, area under the curves; AUROC, area under the receiver-operating characteristics curve; BMI, body mass index; CCL2, CC-chemokine ligand-2; CI, confidence interval; CT, computed tomography; ECM, extracellular matrix; ELF, European liver fibrosis; FT, FibroTest; Fibrosis; GGT, gamma-glutamyl-transpeptidase; HA, hyaluronic acid; HTGC, hepatic triglyceride levels; LSM, liver stiffness; MRE, magnetic resonance elastography; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; NAFL, non-alcoholic fatty liver; NAFLD; NAFLD, non-alcoholic fatty liver disease; NASH; NASH, non-alcoholic steatohepatitis; NFS, NAFLD fibrosis score; NPV, negative-predictive value; OR, odds ratio; PPV, positive-predictive value; SF, serum ferritin; SPEA, Serum prolidase enzyme activity; TE, transient elastography; TIMP1, tissue inhibitor of metalloproteinase 1; TNF, tumor necrosis factor; TRX, thioredoxin; US, ultrasonography