Noninvasive diagnosis of hepatic fibrosis or cirrhosis

The evaluation of the degree of hepatic fibrosis is especially important in patients with chronic liver disease. The aim of this study was to study the diagnostic accuracy of noninvasive means.

Sixty-three clinical, biochemical (prothrombin index, gamma-glutamyl transpeptidase and apolipoprotein A1 levels [PGA score]; and hyaluronate, alpha2-macroglobulin, N-terminal peptide of type III procollagen, laminin, and transforming growth factor beta1 levels), Doppler ultrasonic, and endoscopic variables were recorded in 243 patients who were divided into four groups: whole, compensated, alcohol-compensated, and viral-compensated liver disease. Diagnostic accuracy was evaluated by discriminant analysis; first globally, then by stepwise analysis.

In three groups, hyaluronate and prothrombin index were the best predictive factors (accuracy, > or =85%). Accuracy for the diagnosis of cirrhosis varied from 89.5% to 95% with global discriminant analysis and from 91% to 94% with stepwise analysis according to the group. In the compensated group, hyaluronate concentration of > or =60 microg/L had a sensitivity of 97% and a specificity of 73%. Diagnostic accuracy was 87% globally for extensive fibrosis. Prothrombin index and hyaluronate were two independent variables predictive of the area of fibrosis (r2 = .66).

With the use of a few noninvasive criteria, cirrhosis can be correctly diagnosed in 91%-94% of patients with chronic liver disease. Serum hyaluronate concentration is the most sensitive variable for screening.