Serum biomarkers for the non-invasive diagnosis of liver fibrosis: The importance of being validated

摘要

Chronic liver diseases (CLDs), including chronic hepatitis C and B, alcoholic and non-alcoholic fatty liver diseases, represent a major cause of morbidity and mortality worldwide. The progressive accumulation of fibrosis in the liver characterizes the natural history of CLDs and represents the hallmark of the evolution towards hepatic cirrhosis and its end-stage complications (1). Staging of liver fibrosis is essential to define prognosis and management of CLDs. Classically, two stages of liver fibrosis are considered relevant by guidelines and clinicians since they significantly modify the management of patients: significant fibrosis, as defined as >F2 by METAVIR classification, and cirrhosis, as defined as F4 by METAVIR. The former is considered a definitive indication for antiviral treatment in chronic viral hepatitis B and C, the latter requires a specific follow-up for the risk of hepatocel-lular carcinoma and esophageal varices (2, 3). Liver biopsy has long been regarded as the gold standard of reference for the staging of fibrosis. However, it has major drawbacks including cost, side effects and risk of underestimation of liver fibrosis stage if sampling is inadequate (4). Accordingly, in the last 10 years many efforts have been dedicated by the researchers towards the identification of surrogate markers able to provide a non-invasive assessment of fibrosis in the liver. A number of serum biomarkers have been proposed for the non-invasive diagnosis of liver fibrosis (1).