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Non-invasive prediction of forthcoming cirrhosis-related complications Kang W; Kim SU; Ahn SHWorld J Gastroenterol 2014[Mar]; 20 (10): 2613-23In patients with chronic liver diseases, identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies, assessing therapeutic response, and stratifying long-term prognosis. Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases, several non-invasive methods have been developed as alternatives to liver biopsies. Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard. However, non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker. Accordingly, recent studies have focused on assessing the performance of non-invasive methods through long-term, longitudinal, follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis. As a result, current view is that these alternative methods can independently predict future cirrhosis-related complications, such as hepatic decompensation, liver failure, hepatocellular carcinoma, or liver-related death. The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events. In this article, we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.|*Decision Support Techniques[MESH]|Biomarkers/blood[MESH]|Biopsy[MESH]|Disease Progression[MESH]|Disease-Free Survival[MESH]|Elasticity Imaging Techniques[MESH]|Humans[MESH]|Kaplan-Meier Estimate[MESH]|Liver Cirrhosis/blood/*complications/*diagnosis/mortality[MESH]|Predictive Value of Tests[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Severity of Illness Index[MESH]|Time Factors[MESH] |
