Noninvasive biochemical markers of liver fibrosis.

The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decision. Although needle biopsy of the liver is the gold standard for fibrosis assessment, it has some technical limitations and risks. This has led to the development of noninvasive biochemical markers of liver fibrosis: direct markers which reflect extracellular matrix turnover and indirect markers which reflect alterations in hepatic function. Markers associated with matrix deposition or degradation and some cytokines implied in fibrosis may be used as individual markers or as combination of markers to generate an algorithm to evaluate the stage of fibrosis. Also, fibrosis may be predicted by using indirect markers as a single routine laboratory test or multicomponent indirect fibrosis tests. Serum markers are of great value not only in patients at risk for liver biopsy, but also as a part of the assessment of patients with chronic liver disease avoiding the invasive methods.