Tuesday, November 20, 2018

Physician Tips: Taking the Complexity Out of Liver Test Interpretation

Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end‐stage liver disease. Consequently the degree of liver fibrosis is one of the most important diagnostic and prognostic assessments in chronic liver disease.1

Yet the standard diagnostic tests for early liver disease, short of biopsy, remain less than ideal. (published site)

On the spectrum of NAFLD, simple steatosis often remains stable for a number of years never progressing in many patients, but a subset of these patients are at a higher risk of progressing to cirrhosis, portal hypertension, or hepatocellular carcinoma (HCC).2

In the absence of decompensated cirrhosis, liver biopsy is still considered by many as the only reliable means to determine prognosis based on the severity of fibrosis. Nevertheless, biopsy remains a relatively inefficient determination of fibrosis due to the natural size and shape of the liver. Even optimally sized liver biopsies reflect a tiny fraction of the organ, which is insufficient in diseases where fibrosis can be unevenly distributed, and additional sampling increases risk of complications.

The need to assess liver fibrosis in patients without clear indication for biopsy has led to development of a wide range of noninvasive biomarkers for liver diseases ranging from chronic
nonalcoholic steatohepatitis (NASH).

Many of these noninvasive markers (NIMs) for assessing liver fibrosis have been developed and are used in clinical practice. They have been validated in different studies, and have shown an impressive range of diagnostic certainty approaching that achieved with liver biopsy.3

More and more clinicians are ordering these tests for their ease of testing, negligible complication rates, repeatability, and low cost, for selecting patients for biopsy referral.

Improving on the accuracy of these single index-based tests, are newer multivariate indices offering simple numeric scores or values as representative of an underlying disease process and combine the power of two or more indices.

The FibroTest is the first of these combination indices to achieve prognostic value comparable to a 25mm biopsy.4 Nevertheless there is an average disparity of 25 percent between FibroTest and biopsy, with half of these variances attributable to biopsy error, and the other half to FibroTest.

Building on the success of that test, Fibronostics used machine learning to further refine accuracy and ease of interpretation. LiverFASt™ combines demographic markers with the values of FibroTest™, ActiTest™ and SteatoTest™ into a single non-invasive blood test that provides physicians with simultaneous and complete assessment of liver injury including: liver fibrosis and necroinflammatory activity for patients with Hepatitis C or B Virus, Alcoholic Liver Disease, and Non-Alcoholic Fatty Liver Disease (NAFLD).

In addition LiverFASt™ and the more streamlined LiverFASt Select are not sent to you in a complicated table of dozens of blood chemistries, the results are fed into software that produces an easy-to-read and interpret report that you can share with patients in a clear and understandable format.

Fibronostics is committed to leveraging the benefits of technology to improve lives, and deliver high-quality, life-improving disease education, evaluation and monitoring. For more information contact us via email, or by phone at 1-888-552-1603.

1 R.A. Standish, E Cholongitas, et al; An appraisal of the histopathological assessment of liver fibrosis. Gut vol. 55, Issue 4
2 Dam‐Larsen S, Franzmann M, Andersen IB, Christoffersen P, Jensen LB, Sorensen TIA, et al. Long term prognosis of fatty liver: risk of chronic liver disease and death. Gut 2004; 53: 750–755.
3 F.M. Sanai and E.B. Keeffe; Liver Biopsy for Histological Assessment –The case against. Saudi J Gastroenterol 2010 Apr; 16(2): 124–132.
4 Naveau S (2009). "Diagnostic and prognostic values of non-invasive biomarkers of fibrosis in patients with alcoholic liver disease". Clin Gastroenterol Hepatol49: 97–105. 

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