Alcohol is the leading cause of cirrhosis and liver-related mortality, but we lack serum markers to detect compensated disease.
Dr Maja Thiele and colleagues of Denmark compared the accuracy of the Enhanced Liver Fibrosis test, the FibroTest, liver stiffness measurements and 6 indirect marker tests in detection of advanced liver fibrosis.
The research team performed a prospective study of 10 liver fibrosis markers, all performed on the same day.
Patients were recruited from primary centers and secondary health care centers in the region of Southern Denmark from 2013 through 2016.
Biopsy-verified fibrosis stage was used as the reference standard.
The team's primary aim was to validate Enhanced Liver Fibrosis test in detection of advanced fibrosis in patients with alcoholic liver disease recruited from primary and secondary health care centers, using the literature-based cutoff value of 10.5.
Secondary aims were to assess the diagnostic accuracy of Enhanced Liver Fibrosis test for significant fibrosis and cirrhosis and to determine whether combinations of fibrosis markers increase diagnostic yield.
The Enhanced Liver Fibrosis test identified patients with advanced liver fibrosis with an area under the receiver operating characteristic curve of 0.92,
The research team observed that findings did not differ significantly between patients from primary vs secondary care.
Enhanced Liver Fibrosis test more accurately identified patients with advanced liver fibrosis than indirect marker tests, but Enhanced Liver Fibrosis test and FibroTest had comparable diagnostic accuracies.
|Enhanced Liver Fibrosis test values below
10.5 had negative predictive values for
advanced liver fibrosis
Results from the Enhanced Liver Fibrosis test and FibroTest did not differ significantly from those of liver stiffness measurement in intention-to-diagnose analyses, but did differ in the per-protocol analysis.
The team noted that adding a serum marker to transient elastography analysis did not increase accuracy.
For patients in primary care, Enhanced Liver Fibrosis test values below 10.5 and FibroTest values below 0.58 had negative predictive values for advanced liver fibrosis of 98% and 94%, respectively.
Dr Thiele's team concluded, "In a prospective, direct comparison of tests, Enhanced Liver Fibrosis test and FibroTest identified advanced liver fibrosis in alcoholic patients from primary and secondary care with high diagnostic accuracy."
"Advanced fibrosis can be ruled out in primary health care patients based on an Enhanced Liver Fibrosis test value below 10.5 or a FibroTest value below 0.58."