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01.12.2012 | Review | Ausgabe 1/2012 Open Access

Comparative Hepatology 1/2012

Systematic review of the diagnostic performance of serum markers of liver fibrosis in alcoholic liver disease

Comparative Hepatology > Ausgabe 1/2012
Julie Parkes, Indra Neil Guha, Scott Harris, William MC Rosenberg, Paul J Roderick
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-5926-11-5) contains supplementary material, which is available to authorized users.

Competing interests

Professor William Rosenberg has received honararia for lecturing from Siemens Diagnostics.

Authors’ contributions

JP and ING conducted the literature search and data extraction; SH participated in design and construction of quantitative display of data synthesis and provided statistical support, PJR and WR conceived of the study, participated in the design of the study, provided additional resource for literature search and study selection, and helped draft manuscript. All authors read and approved the final manuscript.



Alcoholic liver disease (ALD) is a significant cause of death and morbidity. Detection of liver fibrosis at an early stage could provide opportunities for more optimal management. Serum markers of liver fibrosis offer an alternative to biopsy. Evidence of the performance of biomarkers in ALD is needed and a systematic review to evaluate available studies was conducted.


Electronic databases were searched. Studies were included if they evaluated paired samples of biopsy and serum, and presented data as sensitivity, specificity, or ROC curves.


15 studies were included- median participant number = 146 (range 44–1034). Studies differed with respect to patient populations. 6 single markers were evaluated (mostly Hyaluronic Acid), and ten combined panels. Biomarkers could discriminate between people with severe fibrosis/cirrhosis with high diagnostic accuracy- HA (median AUROC 0.79 range 0.69-0.93), panels (median AUROC 0.83 range 0.38-0.95). Significant heterogeneity precluded pooling. Performance was poorer for detecting less severe fibrosis.


There are limited numbers of small studies evaluating the accuracy of biomarkers in identifying fibrosis on biopsy in ALD. Some showed promise (both HA alone and some panels) in the identification of cirrhosis/severe fibrosis and could be used to rule it out in heavy drinkers. Biomarkers less accurate with less severe fibrosis.
Authors’ original file for figure 1
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