Table 1.
Blood-based tests for assessment of liver fibrosis
| Direct markers | Indirect markers |
|---|---|
| Extracellular matrix deposition | Liver enzymes |
| Hyaluronic acid | Serum alanine aminotransferase (ALT) |
| Laminin | Serum aspartate aminotransferase (AST) |
| Procollagen I peptide | The AST/ALT ratio (AAR) |
| Procollagen III peptide | AST to platelet ratio index (APRI) |
| Type I collagen | |
| Type IV collagen | Indirect biomarkers used in panels |
| YXL-40 (chondrex) | Gamma glutamyl transferase (GGT) |
| Extracellular matrix degradation | Serum haptoglobin |
| Matrix metalloproteinase (MMP) -1,-2 | Alpha2-macroglobulin |
| Tissue inhibitor of metalloproteinase (TIMP) | Apolipoprotein A1 |
| Cytokines | Serum bilirubin |
| Transforming growth factor-alpha (TGF-α) | Serum cholesterol |
| Transforming growth factor-beta (TGF-β) | Platelet count |
| Platelet derived growth factor (PDGF) | |
| Panels of serum tests (with or without other clinical parameters) | |
| Forns index—age, platelet count, cholesterol level, gamma glutamyl transferase (GGT) | |
| FibroTest® or FibroSure®—age, gender, serum haptoglobin, alpha2-macroglobulin, apolipoprotein A1, GGT, and bilirubin | |
| Hepascore—age, gender, bilirubin, GGT, Hyaluronic acid and alpha2-macroglobulin | |
| PGA and PGAA index—GGT, the prothrombin index, apolipoprotein A and alpha2-macroglobulin | |
| ACTI test—Fibrotest+ALT | |
| Fibro-index—platelet count, AST, and gamma globulin | |
| FIB-4 score—age, platelet count, AST, gamma globulin | |
| NAFLD fibrosis score (NFS)—age, body mass index (BMI), blood glucose levels, ALT, AST, platelet count and albumin | |
| Fibrometer™—age, platelet count, prothrombin index, AST, alpha2-macroglobulin, hyaluronic acid, BUN | |
| BARD score—BMI, AAR, and Diabetes (presence/absence) | |
| FibroSpect-II—Hyaluronic acid, TIMP-1 and alpha2-macroglobulin | |
| Enhanced liver fibrosis (ELF™) panel—Hyaluronic acid level, amino-terminal propeptide of type III collagen level, and TIMP-1 | |