Table 1.
Established serum marker tools.
| Name | Biomarker Involved | Cutoff |
|---|---|---|
| Liver function test or liver damage test [77,80] |
AST/ALT ratio | In chronic viral hepatitis, values of 1.0 are identified as the cutoff: below it, patients are not at risk of cirrhosis. Major values are seen in manifested cirrhosis. |
| APRI—AST Platelet Ratio Index [54,57,77,79,80,81] |
AST (UI/L)/platelet count (109/L) × 100 | NAFLD/MASLD disease has a 1.0 cutoff: minor values identify low risk (NPV = 84%); major values identify high risk (PPV = 37%). AUROC: 0.67. In HCV infection, values below 1.0 identify low risk (NPV = 100%). Values greater than 2.0 identify high risk (PPV = 65%); intermediate values (1.0; 2.0) are indeterminate. AUROC: 0.94 In HBV infection, the cutoff is 1.0–1.5: less for low risk (NPV = 86%), more for high risk (PPV = 39%). AUROC: 0.75 It is utilized also in ALD, but cutoffs have not been identified yet. |
| FIB4—fibrosis 4 [54,59,63,77,79,80,81] |
[age (years) × AST(UI/L)]/platelet count (109/L) × ALT (UI/L)]2 | In NAFLD/MASLD disease, values below 1.30 stand for low risk (NPV = 90%); values greater than 2.67 for high risk (PPV = 80%); intermediate values (1.30; 3.35) are indeterminate. AUROC: 0.80 In HCV infection, values lower than 1.45 identify a low risk for advanced fibrosis (NPV = 90%), values greater than 3.25 identify a high risk for advanced fibrosis (PPV 65%), and values greater than 5.88 stand for a high risk for advanced fibrosis (PPV = 82.5%). Intermediate values (1.45; 3.25) are indeterminate. AUROC: 0.765–0.83. In HBV infection, values less than 1.58 identify a low risk for advanced fibrosis (NPV = 84.6%) and values greater than 5.17 identify a high risk for advanced fibrosis (PPV 83.3%). Intermediate values (1.58–5.17) are undetermined. AUROC: 0.845 |
| Fibrotest or FibroSure [77,79] |
α2-Macroglobulin, apolipoprotein A1, haptoglobin, γ-glutamyl transpeptidase, bilirubin | In NAFLD/MASLD disease, the identified cutoff value is 0.30 (NPV = 97%). AUROC: 0.88 In HCV infection, the identified cutoff value is 0.52 (NPV = 94%). AUROC: 0.84 In HBV infection, the identified cutoff value is 0.48 (NPV = 90%) AUROC: 0.82 |
| FORN index [59,63,79] |
Platelet count, cholesterol levels, age, γ-glutamyl transpeptidase | AUROC: 0.76 for fibrosis detection and AUROC: 0.87 for cirrhosis detection |
| Hepascore [63,77,79] |
HA, bilirubin, GGT, α2-macroglobulin, age, gender | In NAFLD/MASLD disease, the identified cutoff value is 0.37 (NPV = 97%). AUROC: 0.81 In HCV disease, the identified cutoff value is 0.47 (NPV = 95%). AUROC: 0.86 In HBV infection, the identified cutoff value is 0.42 (NPV = 90%). AUROC: 0.82 |
| Fibrometer [63,79] |
Glucose, AST, ferritin, platelet count, ALT, body weight, age | AUROC: 0.82 for fibrosis detection and AUROC: 0.91 for cirrhosis |
| Cirrhometer [79] |
Fibrometer with specific coefficients | |
| NFS—NAFLD Fibrosis Score [77] |
Age, body mass index, hyperglycemia, platelet count, albumin, AST/ALT Ratio | In NAFLD/MASLD disease, values <−1.455 stands for no advanced fibrosis/low risk (NPV = 88%), while values >−0.675 stand for advanced fibrosis/high risk (PPV = 82%). Intermediate values (>−1.455 and <−0.675) are indetermined. AUROC: 0.82–0.85 |
| ELF panel—Enhanced Liver Fibrosis panel [63,77,81,82] |
HA, TIMP-1, PIIINP | In NAFLD/MASLD disease, the identified cutoff is 10.35 (NPV = 94%). AUROC: 0.94 In HCV infection, the identified cutoff is 0.063 (NPV = 95%). AUROC: 0.773 In HBV infection, the identified cutoff is 8.4 (NPV = 88%). AUROC: 0.69 |
| MAF-5 Metabolic Dysfunction Associated Fibrosis Score [83] |
Waist circumference, body mass, AST, platelet count | In metabolic dysfunction, values less than 0 identify no fibrosis risk (NPV = 96.7%), while values greater than 1 identify a high fibrosis risk (PPV = 28%). |
Table 1: Low risk for significant fibrosis stands for Kleiner or METAVIR score F0–2; advanced fibrosis F3–4; cirrhosis F4. NPV—negative predictive value; PPV—positive predictive value; AUROC—area under the receiver operating characteristic curve.