Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease.
Alcoholic liver disease (ALD) consists of a broad spectrum of disorders, ranging from simple steatosis to alcoholic steatohepatitis and cirrhosis. Fatty liver develops in more than 90% of heavy drinkers, however only 30%-35% of them develop more advanced forms of ALD. Therefore, even if the current "gold standard" for the assessment of the stage of alcohol-related liver injury is histology, liver biopsy is not reasonable in all patients who present with ALD. Currently, although several non-invasive fibrosis markers have been suggested as alternatives to liver biopsy in patients with ALD, none has been sufficiently validated. As described in other liver disease, the diagnostic accuracy of such tests in ALD is acceptable for the diagnosis of significant fibrosis or cirrhosis but not for lesser fibrosis stages. Existing data suggest that the use of non-invasive tests could be tailored to first tier screening of patients at risk, in order to diagnose early patients with progressive liver disease and offer targeted interventions for the prevention of decompensation. We review these tests and critically appraise the existing evidence.
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London NW3 2QG, United Kingdom.
Rosa
R
Lombardi
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London NW3 2QG, United Kingdom.
Elena
E
Buzzetti
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London NW3 2QG, United Kingdom.
Davide
D
Roccarina
Rosa Lombardi, Elena Buzzetti, Davide Roccarina, Emmanuel A Tsochatzis, Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London NW3 2QG, United Kingdom.
Emmanuel A
EA
Tsochatzis
D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods; D054459:Elasticity Imaging Techniques; D005235:Fatty Liver, Alcoholic / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000175:diagnosis*; D008111:Liver Function Tests / Q000379:methods; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D015415:Biomarkers
AST-to-platelet ratio index; Cirrhosis; Collagen proportionate area; Cost-effectiveness; Diagnostic accuracy; Fibrotest; Histology; Prognosis; Serum fibrosis markers; Transient elastography