Original articles
Biomarkers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease

https://doi.org/10.1016/S1542-3565(04)00625-1Get rights and content

Background & Aims: The aim of this study was to determine the diagnostic use of noninvasive markers of fibrosis in patients with chronic alcoholic liver disease. Methods: A total of 221 consecutive patients with an alcohol intake of >50 g/day (median, 100 g/day) and available liver biopsy examination and FibroTest FibroSure (FT) results were included prospectively. Fibrosis was assessed blindly on a 5-stage histologic scale similar to that of the METAVIR scoring system. Hyaluronic acid was measured and used as a standard serum marker of fibrosis. Results: Advanced fibrosis (F2–F4) was present at biopsy examination in 63% of patients. The mean FT value (SE) was F0 = .29 (.05); F1 = .29 (.03), F2 = .40 (.03), F3 = .53 (.04); and F4 = .88 (.02) (P < .05 between all groups, except between F0 and F1). As opposed to FT, there was no significant difference for hyaluronic acid between F2 and F1 and between F2 and F0. For F2–F4 vs. F0–F1, the FT area under the ROC curves (AUROC) = .84 (.03) and .79 (.03) for hyaluronic acid. For the diagnosis of F4, the AUROC was very high, .95 for FT and .93 for hyaluronic acid. The discordances of the 2 stages were attributed to biopsy failures in 26 cases and to FT failures in 13 cases. Conclusions: In heavy drinkers, FT is a simple and noninvasive quantitative estimate of liver fibrosis. The use of FT may decrease the need for liver biopsy examination.

Section snippets

Study population

Patients with available serum levels and a consistent liver biopsy examination were included. These patients were included prospectively in a cohort of alcoholic patients for which one primary end point was the identification of biochemical markers. 11, 13, 34, 35 All patients had a self-reported daily alcohol consumption equivalent to at least 50 g of pure ethanol during the preceding year, with a mean of 146 g/day (SE, 80 g/day) for 17 (SE, 10) years. Information of alcohol consumption was

Patients

The 221 included patients were not different from the 71 patients who were not included (Table 1). The majority (93%) had some degree of fibrosis, 31% had cirrhosis, and 29% had alcoholic hepatitis. The mean interval between the serum sample for biochemical markers and the liver biopsy was 1 day (mean), 8 the median 9 days, and range of 31 days before to 6 days after. All patients included were actively drinking in the period prior to admission. The cause of admission was alcoholism without

Discussion

Our results show that for the assessment of fibrosis, FT has high predictive values for the diagnosis of clinically significant lesions in chronic alcoholic liver disease.

Our study has several limitations that must be acknowledged. First, despite the use of a prospective cohort and the prospective assessment of 5 FT components, the haptoglobin level assessment was made retrospectively. Nevertheless, the analyses of histologic specimens and biochemical markers were performed blindly, and the

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    Supported by grants from the Association pour la Recherche sur le Cancer and the Association de Recherche sur les Maladies Virales Hépatiques (to T.P.). T.P. is a consultant for and owns shares in Biopredictive, the company marketing FibroTest-ActiTest.

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