Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease

Table 1 Non-invasive serum tests for the assessment of liver fibrosis and corresponding stages of alcoholic liver disease diagnosed

Test	Variables	ALD stage assessed
AST:ALT ratio	ALT, AST	≥ F1, F4
HA	HA	F4
PGA	PT, GGT, apolipoprotein-A1	F4
PGAA	PT, GGT, apolipoprotein-A1, α2-macroglobulin
FibroTest®	Haptoglobin, α2-macroglobulin, apolipoprotein-A1, bilirubin, GGT	≥ F3, F4
FibrometerA®	Age, weight, glucose, AST, ALT, PLT count, ferritin	≥ F3, F4
FIB-4	Age, AST, ALT, platelet count	≥ F3
Hepascore®	Age, sex, bilirubin, GGT, α2-macroglobulin, HA	≥ F3, F4
APRI	AST, platelet count	≥ F2, F4
ELF test™	HA, PIIINP, TIMP-1	≥ F3, F4
Forns index	Age, platelet count, total cholesterol, GGT	≥ F3, F4

ALD: Alcoholic liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PT: Prothrombin time; GGT: γ-glutamyl transpeptidase; PLT: Platelets; PIIINP: Terminal peptide of procollagen III; TIMP-1: Tissue inhibitor of metalloproteinase 1; HA: Hyaluronic acid.

Table 2 Non-invasive serum tests to diagnose fibrosis in patients with alcoholic liver disease and corresponding diagnostic indexes

Test	Cut-offs	F3			F4
		Sensitivity	Specificity	AUROC	Sensitivity	Specificity	AUROC
PGA	< 2	NA	NA	0.84	0%	83%	NA
	> 9	NA	NA	NA	86%	100%	0.89
PGAA	< 3	NA	NA	0.86	NA	NA	NA
	> 12	NA	NA	NA	NA	NA	0.83
Hyaluronic acid, μL	> 55	83.0%	69%	NA	NA	NA	NA
	> 60	NA	NA	NA	100%	60%-86%2	NA
	> 100	NA	NA	NA	89%	87%	NA
	> 250	NA	NA	NA	100%	69%	0.78
APRI	< 0.5	NA	NA	NA	NA	NA	NA
	> 1.5	13.2%	77.6%	0.43-0.72	NA	NA	NA
	< 1	NA	NA	NA	NA	NA	NA
	> 2	9.4%	96.6%	NA	16.9%	86.4%	0.56-0.792
FIB-4	< 1.45	NA	NA	0.7	NA	NA	0.8
	> 3.25	NA	NA	0.7	NA	NA	0.8
FibroTest®	< 0.3 (0.3-1.581)	84.0%	66%	0.79	100%	50%	0.84
	> 0.7 (0.7-1.01)	55.0%	93%	0.83	91%	87%	0.94
FibroMeter®	NA	91.8%	92.3%	0.82-0.882	91.8%	92.3%	0.85-0.942
ELF test™	< 0.431	93.3%	100%	0.94	93.3%	100%	0.94
	> 9.5	74.4%	92.4%	NA	74.4%	92.4%	NA
Hepascore®	NA	NA	NA	0.76-0.832	NA	NA	0.76-0.922
Forns	NA	NA	NA	0.38	NA	NA	0.38

¹A single cut-off has not been validated;

²A single value has not been proposed. NA: Not available; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AUROC: Area under receiver operator characteristic curve; GGT: γ-glutamyl transpeptidase; PLT: Platelets; PT: Prothrombin time; PIIINP: Terminal peptide of procollagen III; TIMP-1: Tissue inhibitor of metalloproteinase 1; APRI: Aspartate aminotransferase to platelets ratio; ELF: Enhanced liver fibrosis.