Noninvasive, serum-based evaluation of liver fibrosis in metabolic (dysfunction)-associated fatty liver disease

Abstract

Advanced hepatic fibrosis is the most relevant prognostic factor in patients with metabolic (dysfunction)–associated fatty liver disease (MAFLD), being a significant predictor of both liver-related and all-cause mortality. While liver biopsy remains the reference standard for the diagnosis of advanced fibrosis, several known shortcomings (e.g., invasive nature, interobserver variability, and procedural complications) ultimately limit its routine use in clinical practice. To overcome these issues, considerable attention has been recently devoted to identifying serum-based diagnostic panels, which may accurately detect liver fibrosis in a noninvasive fashion. In this chapter, we review the current status of serum-based modalities for the diagnosis and staging of liver fibrosis in patients with MAFLD and nonalcoholic fatty liver disease (NAFLD). Both serum-based noninvasive diagnostic panels, including Fibrosis-4 Index, NAFLD Score, and Aspartate Transaminase-to-Platelet Ratio, and panels comprising markers of collagen turnover and extracellular matrix remodeling parameters, including enhanced liver fibrosis test (ELF), FibroMeter, and FibroTest, will be examined. In general, simple serum-based models are initially used for excluding the presence of advanced fibrosis. In presence of indeterminate results, the use of diagnostic panels (e.g., ELF) or imaging modalities should be recommended as a second-level screening tool. However, diagnostic sensitivity remains suboptimal, and this should encourage future research aimed at optimizing overall accuracy.