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Cheng et al. Advances in liver fibrosis

Table 1: Serum test formulae for liver fibrosis
Parameters or index Formula
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APRI AST (ULN) × 100 / platelet (10 /L)
Forns index 7.811 - 3.131 × ln(platelet count) + 0.781 × ln(GGT) + 3.467 × ln(age) - 0.014 × (cholesterol)
1/2
9
FIB-4 Age (years) × AST [U/l] / (platelets [10 /L] × (ALT [U/L]) )
9
Fibro index 1.738 - 0.064 × platelet [10 /L]) + 0.005 × AST [IU/L] + 0.463 × gamma globulin [g/dL]
Hui index exp(3.148 + 0.167 × BMI + 0.088 × bilirubin [µmol/L] - 0.151 × albumin [g/L] - 0.019 × platelet [10 /L]) / (1 +
9
exp(3.148 + 0.167 × BMI + 0.088 × bilirubin [µmol/L] - 0.151 × albumin [g/L] - 0.019 × platelet [10 /L]))
9
2
NFS -1.675 + 0.037 × age (years) + 0.094 × BMI (kg/m ) + 1.13 × impaired fasting glycaemia or diabetes (yes = 1, no
= 0) + 0.99 × AST/ALT ratio - 0.013 × platelet (× 10 /L) - 0.66 × albumin (g/dL)
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BAAT score BMI (≥ 28 = 1, < 28 = 0) + age at liver biopsy (≥ 50 years = 1, < 50 = 0) + ALT (≥ 2 × (ULN) = 1, < 2 × ULN = 0)
+ serum triglycerides (≥ 1.7 mmol/L = 1, < 1.7 = 0)
ALT: alanine aminotransferase; APRI: aspartate aminotransferase to platelet ratio index; AST: aspartate aminotransferase; BAAT: BMI,
age, ALT, triglycerides; BMI: body mass index; FIB-4: fibrosis-4; GGT: gamma-glutamyl transferase; NFS: non-alcoholic fatty liver disease
(NAFLD) fibrosis score; ULN: upper limit of normal
Table 2: Different non-invasive approach
Non-invasive tests Features Advantages Disadvantages
Radiological
Transient Ultrasound-based liver stiffness Useful across different liver disease entity Less reliable in obese patients
elastography measurement by shear wave Special probes designed for different body Less reliable in severe acute
velocity by a specific probe built exacerbation of hepatitis
Measure liver fat at the same time with Less reliable in post-treatment
CAP fibrosis stages in CHB or CHC
Can identify no or minimal fibrosis patients
Acoustic radiation Ultrasound-based wave No additional apparatus except ultrasound Narrow range of measurement
force impulse propagation speed measurement machine Difficult to define a cut-off
imaging by conventional probe Can reflect disease progression More experienced operators need
Real-time results
Less technical difficulties
Accurate in overweight or obese patients
Shear wave Ultrasound measurement of shear No additional apparatus except ultrasound Limited studies on its clinical
elastography wave velocity machine application
Elasticity can be reflected by numbers or
colors
Sensitive for early-stage fibrosis
Results can be expressed into kPa or m/s
Magnetic resonance Phase contrast imaging depending Less operator-dependent and less High cost
elastography on mechanical wave propagation technical failure Limited availability in some countries/
Limited effect by obesity or ascites regions
Can assess complications More time-consuming
Sensitive for early-stage fibrosis Not applicable on patients with iron
Reproducible results overload or hemochromatosis
Limited studies on its clinical
application
Serum test formulae
Common laboratory Refer to Table 1 Results from routine liver function test, Cannot be used for all chronic liver
parameters convenient to perform diseases
No inter-observer variations
FibroTest Consists of GGT, total bilirubin, α-2 Useful in different chronic liver disease Suboptimal for early stage fibrosis
macroglobulin, apolipoprotein A1, Reliable
and haptoglobin Applicable
Accurate in overweight or obese patients
FibroMeter First 2 generations: consists of With high fibrosis classification accuracy High cost
platelets, prothrombin index, AST, Good predictive value for severe fibrosis in
α-2 macroglobulin, hyaluronate, different liver disease entities
urea and age
3rd generation (3G): hyaluronate
does not take into account
Enhanced liver Consists of 3 direct blood markers: Good prognostic factor for clinical Not sensitive for early stages of
fibrosis procollagen III amino terminal outcomes in patients with chronic liver fibrosis
peptide, hyaluronic acid and tissue diseases Age, low CD4+ T-cell count and
inhibitor of metalloproteinase I Similar results by using fresh blood or other factors can affect ELF results
cryopreserved blood
Sensitive for advanced fibrosis or cirrhosis
AST: aspartate aminotransferase; CAP: controlled attenuation parameter; CHB: chronic hepatitis B; CHC: chronic hepatitis C; ELF:
enhanced liver fibrosis
Hepatoma Research ¦ Volume 3 ¦ August 08, 2017 159