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Non-invasive assessment of liver fibrosis in patients with chronic hepatitis B

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Abstract

In patients with chronic hepatitis B (CHB), liver fibrosis assessment is essential not only for determining prognosis but also for identifying patients who should receive treatment. Liver biopsy is limited by its invasiveness and sampling error. To explore effective non-invasive methods for liver fibrosis assessment, we reviewed international literature published over the past decade that focused on patients with CHB. Biomarker panels such as API, FIB-4, Forns Index, HepaScore, FibroMeter, FibroTest, Zeng Index and Hui Index detect advanced fibrosis and cirrhosis with fairly satisfactory accuracy with area under the receiver-operating characteristics curve higher than 0.85. However, most panels and the suggested cutoffs have not been independently validated. Transient elastography is accurate in detecting advanced fibrosis and cirrhosis, and the relative cutoffs have been defined. False-positive results may, however, occur in cases of active necroinflammation and cholestasis. Other promising imaging methods such as acoustic radiation force impulse and magnetic resonance elastography still require further validating studies. We conclude that transient elastography, FibroTest and API are the most widely validated. Transient elastography has been validated as the most useful non-invasive method for liver fibrosis assessment. To improve non-invasive performance of detecting liver fibrosis, a combined application of transient elastography and biomarkers may be the preferred course of action.

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Acknowledgements

We sincerely acknowledge Dr. George M. Davis from George Washington University Medical Center and Vincent Wai-Sun Wong from the Chinese University of Hong Kong for editing the paper and native English usage. This study was partly supported by National Twelfth Five Year Project (2012ZX10002-003).

Conflict of Interest

Yong-Peng Chen, Jie Peng and Jin-Lin Hou declare that they have no conflict of interest.

Compliance with ethical requirements

All the studies with human subjects included in this review article had declared that all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008; informed consent was obtained from all patients for inclusion in the studies. This article does not contain any studies with animal subjects.

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  1. Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Yong-Peng Chen, Jie Peng & Jin-Lin Hou

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  1. Yong-Peng Chen
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Correspondence to Jin-Lin Hou.

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Yong-Peng Chen and Jie Peng contributed equally to this study.

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Chen, YP., Peng, J. & Hou, JL. Non-invasive assessment of liver fibrosis in patients with chronic hepatitis B. Hepatol Int 7, 356–368 (2013). https://doi.org/10.1007/s12072-013-9439-y

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