Is there any non-invasive marker replace the needle liver biopsy predictive for liver fibrosis, in patients with chronic hepatitis?

Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1459-65.


Background/aims: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis.

Methodology: A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC)) were enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/ PLT ratio index (APRI), GGT/PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated.

Results: Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p < 0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p < 0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p > 0.05). But, APRI has showed correlation with liver fibrosis in patients with CHC contrary to patients with CHB.

Conclusion: Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.

MeSH terms

  • Adult
  • Alanine Transaminase / blood
  • Biopsy, Needle / methods*
  • Female
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / pathology*
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / pathology*
  • Humans
  • Liver Cirrhosis / diagnosis*
  • Male
  • Middle Aged
  • Platelet Count
  • gamma-Glutamyltransferase / blood


  • gamma-Glutamyltransferase
  • Alanine Transaminase