Abstract
BackgroundAlcoholic liver disease (ALD) is a significant cause of death and morbidity. Detection of liver fibrosis at an early stage could provide opportunities for more optimal management. Serum markers of liver fibrosis offer an alternative to biopsy. Evidence of the performance of biomarkers in ALD is needed and a systematic review to evaluate available studies was conducted.MethodsElectronic databases were searched. Studies were included if they evaluated paired samples of biopsy and serum, and presented data as sensitivity, specificity, or ROC curves.Results15 studies were included- median participant number = 146 (range 44–1034). Studies differed with respect to patient populations. 6 single markers were evaluated (mostly Hyaluronic Acid), and ten combined panels. Biomarkers could discriminate between people with severe fibrosis/cirrhosis with high diagnostic accuracy- HA (median AUROC 0.79 range 0.69-0.93), panels (median AUROC 0.83 range 0.38-0.95). Significant heterogeneity precluded pooling. Performance was poorer for detecting less severe fibrosis.ConclusionsThere are limited numbers of small studies evaluating the accuracy of biomarkers in identifying fibrosis on biopsy in ALD. Some showed promise (both HA alone and some panels) in the identification of cirrhosis/severe fibrosis and could be used to rule it out in heavy drinkers. Biomarkers less accurate with less severe fibrosis.
Highlights
Alcohol related deaths are an important health concern worldwide
In the UK 85% of such deaths are due to cirrhosis and recent epidemiological studies have shown that mortality rates from cirrhosis are falling in most countries absolute rates remain high, and in the UK and Eastern Europe the trend is upwards with 18% rise in deaths from alcohol related causes between 2000 and 2004 [1,2,3,4,5]
Serum markers of liver fibrosis offer an attractive alternative to liver biopsy, as they are less invasive, may allow dynamic calibration of fibrosis, and are potentially more cost effective
Summary
Alcohol related deaths are an important health concern worldwide. In the UK 85% of such deaths are due to cirrhosis and recent epidemiological studies have shown that mortality rates from cirrhosis are falling in most countries absolute rates remain high, and in the UK and Eastern Europe the trend is upwards with 18% rise in deaths from alcohol related causes between 2000 and 2004 [1,2,3,4,5]. Detection of fibrosis in people drinking hazardously at an early stage or before clinical symptoms of hepatic decompensation could provide opportunities for more optimal management. This is a challenge in a disease process with few characteristic symptoms or signs. Evidence of the diagnostic performance of such serum markers of liver fibrosis in Chronic Liver Disease are needed to assess the clinical utility and effectiveness of such tests in the diagnosis, prognosis and management of liver disease. Evidence of the performance of biomarkers in ALD is needed and a systematic review to evaluate available studies was conducted
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