Non-invasive assessment of liver fibrosis: Between prediction/prevention of outcomes and cost-effectiveness

Table 1 Cut-off values of the first indirect markers of fibrosis in the diagnosis of significant fibrosis and cirrhosis¹

			Cut-off values of some indirect markers
Markers	Algorithm	Aetiology	≥Significant fibrosis	Extensive fibrosis or cirrhosis
APRI		HCV	> 1.5	≥ 2
Wai et al[20], 2003	AST (UI/L)/platelet count (109/L) × 100
FORNS INDEX		HCV	> 6.9
Forns et al[21], 2002	7.811-3.131 × ln (platelet count) + 0.781 × ln (GGT) + 3.467 × ln (age [years]) - 0.014 × ln (cholesterol)
FIBROTEST®Imbert-Bismut et al[22], 2001	Formula combining α-2-macroglobulin, γGT, apolipoprotein A1, haptoglobin, total bilirubin, age and gender	HCV	≥ 0.6
LOK Lok et al[23], 2005	Log odds = -5.56-0.0089 × platelet count (× 103/mm3) + 1.26 × AST/ALT ratio + 5.27 × INR	HCV		≥ 0.5
FIBROINDEX		CLD	≥ 2.25
Koda et al[24], 2007	1.738-0.064 [platelet counts (104/mm3)] + 0.005 × AST (UI/L) + 0.463 [gamma-globulin (g/dL)]
FIB-4		CLD		> 3.25
Vallet-Pichard et al[25], 2007	Age (yr) × AST (UI/L)/[platelet count (109/L)] × [ALT (UI/L)]1/2

¹According to either METAVIR or Ishak scoring system. CLD: Chronic liver disease; AST: Aspartate aminotransferase; GGT: Gamma glutamiltranspepsidasi; ALT: Alanine aminotransferase; INR: International normalized ratio.

Table 2 Cut-off values of stiffness in relation to METAVIR score based on the prevalence of disease in studies conducted before 2009

		Cut off values of stiffness
Authors	Aetiology	≥F2	≥F3	≥F4	PPV/NPV (%)
Castera et al[50]	HCV	7.1			95/48
			9.5		87/81
				12.5	77/95
Ziol et al[51]
	HCV	8.8			88/56
			9.6		71/93
				14.6	78/97
Carrion et al[52]
	HCV post-LT	8.5			79/92
				12.5	50/100
Foucher et al[53]
	CLD	7.2			90/52
			12.5		90/80
				17.6	91/92
Gomez-Dominguez et al[54]
	CLD	4.0			88/50
			11.0		78/76
				16.0	80/98
Kim et al[55]
	CLD	7.3			96/50
			8.8		78/95
				15.0	33/97
Arena et al[56]
	HCV	7.8			83/79
			10.8		89/95
				14.8	73/98

CLD: Chronic liver disease; post-LT: After liver transplantation; HCV: Hepatitis C virus; PPV: Positive predictive value; NPV: Negative predictive value.