Clinical Pearl

Hepascore (liver fibrosis panel) for detection of fibrosis in NASH? This complex model was originally validated for fibrosis scoring in hepatitis C. In NASH, the utility is very limited. In a recent article [Adams et al. Journ Gastro & Hepatol, 2011] Hepascore was evaluated and compared to simple models like APRI (the AST to platelet ratio index). Hepascore was unable to reliably detect significant fibrosis (F2-4), but was able to detect advanced fibrosis (F3-4) and cirrhosis (F4) with reasonable efficacy. Nevertheless, if the risk factors for advanced fibrosis are there (ie. obesity, diabetes, advanced age) and the clinical suspicion is there, do not rely on these non-invasive markers; go for liver biopsy.

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