Non-invasive Biomarkers and FIB-4, APRI Scoring System to Rule out Advanced Liver Injury

Chronic liver Injury (CLI) and its end-stages, cirrhosis, and hepatocellular carcinoma (HCC), are leading causes of morbidity and mortality worldwide with enormous socioeconomic costs. Clinical management of chronic liver injury is dependent on the extent of liver fibrosis. Liver biopsy, the gold standard, is still recommended in most patients. Liver disease diagnosis can generally be made using a carefully obtained history, physical examination, and a few laboratory tests. Initial laboratory testing should include aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin. Biomarkers are being developed as alternatives to liver biopsy for predicting liver fibrosis, Cirrhosis and HCC in patients with chronic liver injury. An intensive research on non-invasive alternatives. A simple, reproducible, low-cost, and non-invasive tool that can follow the evolution of the disease overtime would be beneficial for the testing physician and is desired by the patients. The aim of this review is to summarize Non-Invasive Biomarkers in addition to score systems like FIB-4 and (Aspartate Platelet Ratio Index) APRI in assessment of Fibrosis, Cirrhosis and HCC.