Non-Invasive Scores May Aid in Distinguishing Liver Diseases

Medscape

09-05-2025

Non-invasive biomarkers and scoring systems demonstrated effectiveness in differentiating chronic liver disease (CLD) from cirrhosis; non-invasive fibrosis scores such as the Lok index, King's score, fibrosis index, and non-alcoholic fatty liver disease fibrosis score (NFS) showed strong capability.
METHODOLOGY:
Researchers compared cirrhosis with CLD caused by viral infections, autoimmune conditions, and primary biliary cholangitis, focusing on the comparison of different biomarkers and non-invasive scores and their utility in predicting hepatic steatosis and liver fibrosis.
They conducted a retrospective observational study at a hospital in Romania from January 2021 to December 2023 and included 250 adult patients (median age, 64 years) with a confirmed diagnosis of liver disease.
Blood samples were collected during standard clinical evaluations, and a series of tests were conducted.
The analysis incorporated multiple non-invasive scoring systems, including the fibrosis-4 index; King's score for liver fibrosis; Lok index for liver fibrosis; and various haemogram-derived ratios, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio.
The receiver operating characteristic curve analysis was performed to assess the effectiveness of the scores and haemogram-derived ratios in differentiating CLD from cirrhosis.
TAKEAWAY:
Among the 250 participants, 113 had CLD without cirrhosis (72.57% women) and 137 had liver cirrhosis (34.31% women).
Albumin-bilirubin scores and the risk for mortality were significantly higher in the cirrhosis group than in the CLD group ( P < .001 for both).
< .001 for both). The Lok index demonstrated superior diagnostic accuracy (area under the curve [AUC], 0.89; sensitivity, 86.61%; specificity, 78.85%). Moreover, strong discriminatory power was shown by non-invasive markers, including the King's score (AUC, 0.864), fibrosis index (AUC, 0.856), and NFS (AUC, 0.836).
Patients with cirrhosis had a higher neutrophil-to-lymphocyte ratio ( P < .001) and a lower platelet-to-lymphocyte ratio ( P = .002) than those with CLD.
IN PRACTICE:
"[The study] findings have important clinical implications, particularly in tailoring non-invasive diagnostic strategies to specific patient populations," the authors wrote. "Collectively, these findings may support a more nuanced, etiology-aware application of non-invasive fibrosis scores and inflammatory indices in clinical hepatology," they added.
SOURCE:
This study was led by Abdulrahman Ismaiel, 2nd Department of Internal Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. It was published online on April 29, 2025, in the Journal of Clinical Medicine .
LIMITATIONS:
The study's retrospective design limited causal inferences, and its single-centre nature may have affected generalisability. The lack of long-term follow-up data prevented the assessment of clinical outcomes like decompensation and mortality. Additionally, imaging techniques for the evaluation of liver fibrosis were not incorporated.
DISCLOSURES:
This research was partially funded by an internal grant from the "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. The authors reported having no conflicts of interest.