Non invasive prediction of severe fibrosis in patients with alcoholic liver disease

Objectives - The aim of this study was to assess the diagnostic accuracy of noninvasive markers of liver fibrosis in alcoholic liver disease. Patients and Methods - Fifty-four clinical and biochemical parameters including serum fibrosis markers (hyaluronate and transforming growth Factor beta 1) were analyzed in 146 consecutive heavy drinkers (106 men, 40 women; mean age 49.2 years). Following liver biopsy fibrosis was evaluated using semi-quantitative scoring system (no fibrosis (0) to severe fibrosis (3+)). Multivariate analysis was performed to determine the markers that were best correlated with the fibrosis score. Results - Fifty-nine patients (40.4 %) had severe fibrosis (3+) while 87 (59.6 %) had no fibrosis or moderate fibrosis (0 to 2+). In multivariate analysis, serum hyaluronate and the prothrombin index were the best markers for the prediction of severe fibrosis. Hyaluronate and the prothrombin index had a diagnostic accuracy of 97.1% and 89.7% respectively in the whole population. Finally, significant negative correlation was found between hyaluronate and the prothrombin index (r = -0.86, P < 0.0001). Conclusions - Using only hyaluronate and the prothrombin index, 9 out of 10 alcoholic patients can be correctly classified according to the severity of liver fibrosis.