Noninvasive assessment of liver fibrosis and its clinical significance in nonalcoholic fatty liver disease

Abstract

Liver fibrosis is the most important prognostic factor in patients with nonalcoholic fatty liver disease (NAFLD). Several noninvasive markers for fibrosis, including blood‐based markers and imaging based‐markers have been developed. Indirect fibrosis markers (e.g., fibrosis‐4 index and NAFLD fibrosis score) consist of standard laboratory data and clinical parameters. Given its availability and high negative predictive value for advanced fibrosis, these markers are suitable for screening at primary care. Blood‐based fibrogenesis markers (enhanced liver fibrosis and N‐terminal propeptide of type 3 collagen), ultrasound‐based modalities (vibration‐controlled transient elastography, point shear wave elastography [SWE], and two‐dimensional SWE), and magnetic resonance elastography have high diagnostic accuracy for liver fibrosis and are suitable for diagnosing liver fibrosis at secondary care centers. Sequential use of these markers can increase diagnostic accuracy and reduce health care costs. Furthermore, combining noninvasive makers may assist in identifying candidates for pharmacological trials and reducing screening failure. Emerging data suggest that these noninvasive markers are associated with liver‐related events (hepatocellular carcinoma and decompensation) and mortality. Furthermore, delta change in noninvasive markers over time is also associated with time‐course change in fibrosis, liver‐related event risk, and mortality risk. However, the association between liver fibrosis and cardiovascular disease (CVD) risk is still controversial. CVD risk may decrease in patients with decompensated liver disease and noninvasive markers may be useful for assessing CVD risk in these patients. Therefore, noninvasive markers may be utilized as measures of fibrosis as well as real‐time prognostic tools, in place of liver biopsy.

Effect of fatty liver and fibrosis on hepatocellular carcinoma development in patients with chronic hepatitis B who received nucleic acid analog therapy

“…Liver fibrosis was evaluated using the FIB‐4 index. To examine the association between fatty liver and liver fibrosis, we defined advanced fibrosis as FIB‐4 score of 2.67 or higher, which is the threshold for advanced fibrosis in non‐alcoholic fatty liver disease (NAFLD) 21,22 . Because all patients included in the study had received NA therapy, we evaluated liver fibrosis using the FIB‐4 index 1 year after the NA therapy initiation.…”

Necessity for surveillance for hepatocellualr carcinoma in older patients with chronic hepatitis C who achieved sustained virological response

“…Western guidelines recommend that patients with advanced fibrosis should be screened regularly for HCC 18–20 . Various noninvasive methods have been proposed and used clinically to identify patients with advanced fibrosis and a high risk of HCC 21–26 . On the other hand, since routine HCC surveillance is not cost effective to perform in all patients, screening is not recommended for patients without advanced fibrosis 27 .…”

Pemigatinib treatment for intrahepatic cholangiocarcinoma with FGFR2 fusion detected by a liquid comprehensive genomic profiling test

“…Liver cancer has become the second and sixth most common cause of cancer‐associated deaths in men and women 1 . Hepatocellular carcinoma (HCC) accounts for 75%–85% of patients with liver cancer and is a major health burden worldwide 2,3 . Intrahepatic cholangiocarcinoma (ICC) is a malignant neoplasm occurring in the epithelium of the biliary tract and the second most common primary liver cancer following HCC, accounting for approximately 15% of primary liver cancers and 3% of gastrointestinal tumors 4,5 .…”