Non-invasive prediction of forthcoming cirrhosis-related complications

• Published in: World journal of gastroenterology : WJG 2014-03, Vol.20 (10), p.2613-2623
• Main Authors: Kang, Wonseok, Kim, Seung Up, Ahn, Sang Hoon
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Biopsy; Cirrhosis; Complicati; Decision Support Techniques; Disease Progression; Disease-Free Survival; Elasticity Imaging Techniques; Humans; Kaplan-Meier Estimate; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Non-invasive; Prediction; Predictive Value of Tests; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Topic Highlight
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i10.2613

In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver biopsies.Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard.However,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker.Accordingly,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis.As a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related death.The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events.In this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.