EASL clinical practice guidelines: non-invasive liver tests for evaluation of liver disease severity and prognosis

Abstract

The European Association for the Study of the Liver has recently published updated guidelines on the use of non-invasive tests to identify and stratify chronic liver disease. Here, we provide a summary of the key recommendations from the guideline.

Keywords: alcoholic liver disease; hepatic fibrosis; liver function test; non-alcoholic steatohepatitis; screening.

Figure 1

As presented in the CPG: proposed use of non-invasive tests in patients observed in primary care or outside the liver clinic. As shown, FIB-4 can be used in patients with metabolic cofactors and/or alcoholic liver disease to identify patients requiring referral to the specialist liver clinic. Transient elastography or FIB-4 may be performed before or after referral to liver specialist according to local availability and pathways. Cut-offs to use: ELF<9.8 (NAFLD/ALD), FibroMeter<0.45 (NAFLD) and FibroTest<0.48 (NAFLD). ALD, alcohol-related liver disease; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CPG, clinical practice guidelines; ELF, enhanced liver fibrosis; FIB-4, fibrosis-4; GGT, gamma-glutamyl transferase; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, non-alcoholic fatty liver disease.

Figure 2

As presented in the CPG: proposed use of NITs for risk stratification in patients with compensated chronic liver disease (CLD). CPG, clinical practice guidelines; CSPH, clinically significant portal hypertension; HVPG, hepatic venous pressure gradient; LSM, liver stiffness measurement; NITs, non-invasive tests; PH, portal hypertension; Plt, platelet count.