Detection assessment and monitoring of hepatic fibrosis: biochemistry or biopsy?

Abstract

Hepatic fibrosis is an important consequence of inflammatory disorders affecting the liver, and ultimately progresses to cirrhosis. Here we explore methods for the detection and monitoring of hepatic fibrosis, particularly in hepatitis C, alcoholic liver disease, non-alcoholic fatty liver disease and during methotrexate therapy, in all of which progressive fibrosis can develop over a number of years in a minority of patients. Liver biopsy currently remains the gold standard to assess fibrosis. However, it has several limitations, including manpower issues, cost, risk of patient injury, including mortality and morbidity, observer variability and sampling variation. Several non-invasive diagnostic tests for fibrosis and cirrhosis have therefore been evaluated. The usefulness of a laboratory test for screening for a pathological abnormality such as fibrosis is critically dependent on the prevalence of the pathology in the population under investigation. When the prevalence is expected to be low, screening tests should have a high negative predictive value so that large numbers of patients can be spared the next diagnostic step, namely liver biopsy. For the moment, clinical chemistry laboratories should offer the aspartate aminotransferase alanine aminotransferase ratio, AST/platelet ratio and the Rosenberg fibrosis index as part of their routine service for monitoring the development of hepatic fibrosis.

Therapeutic mechanisms of granulocyte-colony stimulating factor in methotrexate-induced parotid lesion in adult rats and possible role of telocytes: A histological study

“…This parotid damage could be enlightened by another mechanism where MTX binds to dihydrofolic reductase preventing the change of folic to folinic acid (its active form). This, in turn, hinders nucleic acids, amino acids and proteins synthesis with consequent membrane damage, cellular death and altered salivary secretion [41] . Such mechanism was supported by the marked reduction obtained in acinar and ID secretory granules size and content, significant decrease in total protein, amylase activity and acini and ducts' numbers.…”

Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high‐risk for hepatocellular carcinoma

“…However, these noninvasive tests are cumbersome, expensive, and do not fulfill the criteria of an ideal test for hepatic fibrosis. [17][18][19][26][27][28] Liver biopsy and most noninvasive tests are not feasible for communitybased screening; and another simple, inexpensive, accurate, and easily applicable parameter is necessary. The platelet count is a simple test, and its results are determined easily by routine laboratory procedure.…”

Review and Recommendations for the Component Tests in the Liver Function Test Profile

“…We need to be specific about what we are trying to detect in an LFT screening test. It has long been recognised that ALT elevation is poorly correlated with the severity of histologic liver disease in chronic liver disease [24,25]. Mofrad et al [26] reported on a cohort of patients with normal ALT levels who were diagnosed as having NAFLD histologically and identified clinically (persistent hepatomegaly) or because the subjects were live liver transplant donors.…”