Noninvasive Methods to Evaluate Liver Fibrosis in Chronic HCV Infection

Sirli et al.'s (1) effort to compare several noninvasive methods of fibrosis assessment in chronic hepatitis c virus (hcv) infection is commendable. their study evaluated several simple serological tests for the prediction of fibrosis in chronic hcv infection: number of platelets, the aspartate aminotransferase–platelet ratio index (apri test), the forns score, the lok score, and the fib-4 score. they also compared these tests to liver stiffness measurement (lsm) by transient elastography (te) and to the current “gold standard”: liver biopsy (lb). they concluded that lsm was the best method for predicting cirrhosis, but all the evaluated tests had excellent predictive value (1). we have to keep in mind that lsm failure can occur in 2%-10% of patients, and this is generally related to obesity, especially with the use of the m probe.