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Laboratory Tests in Liver Diseases

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Diagnosis of Liver Disease

Abstract

Laboratory tests for evaluating liver diseases are essential. This chapter reviews routine biochemical tests and disease-specific laboratory tests. Algorithms for assessing acute and chronic hepatobiliary enzyme elevation are suggested. The degree of hepatic fibrosis has been established to be the most significant determinant of mortality/morbidity in chronic liver diseases. Liver biopsy is the gold standard for the diagnosis of hepatic fibrosis, but it has several drawbacks such as invasiveness, cost, and risk. We here review noninvasive fibrosis parameters, including hepatic fibrosis markers, and several scoring systems. Nonalcoholic fatty liver disease (NAFLD) is becoming the most common liver disease all over the world. Diagnostic algorithm for NAFLD is also established to detect severe fibrosis (stage 3/4). Severity of cirrhosis was usually assessed by Child-Pugh score, MELD score, and ALBI grade. We also discuss the significance of tumor markers such as α-fetoprotein (AFP), fucosylated AFP, and des-gamma-carboxyprothrombin in order to detect liver cancer and evaluate its treatment efficacy.

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Abbreviations

AA:

Aromatic amino acid

AASLD:

American Association for the Study of Liver Diseases

ACA:

Anti-centromere antibodies

ACG:

American College of Gastroenterology

AFP:

α-fetoprotein

AFP-L3:

Fucosylated AFP

AIH:

Autoimmune hepatitis

ALBI:

Albumin-bilirubin

ALD:

Alcoholic liver disease

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

ANA:

Antinuclear antibodies

anti-LKM:

Antibodies to liver/kidney microsome

APASL:

Asian Pacific Association for the Study of the Liver

APRI:

AST to platelet ratio index

ARFI:

Acoustic radiation force impulse

ASMA:

Anti-smooth muscle antibodies

AST:

Aspartate aminotransferase

AAR:

AST to ALT ratio

BCAA:

Branched-chain amino acid

BTR:

BCAA/tyrosine ratio

CHB:

Chronic hepatitis B

CHC:

Chronic hepatitis C

CK:

Creatine kinase

CLD:

Chronic liver disease

DCP:

Des-γ-carboxyprothrombin

DIC:

Disseminated intravascular coagulation

DILI:

Drug-induced liver injury

EASL:

European Association for the Study of the Liver

ECM:

Extracellular matrix

ELF score:

Enhanced liver fibrosis score

FIB4 index:

Fibrosis-4 index

GGT:

γ-glutamyl transferase

GPC3:

Glypican-3

GPI:

Glycosylphosphatidylinositol

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

HPLC:

High-performance liquid chromatography

HSC:

Hepatic stellate cell

HSPG:

Heparan sulfate proteoglycan

ICG:

Indocyanine green

ICP:

Intrahepatic cholestasis of pregnancy

IFN-γ:

Interferon-γ

IgA:

Immunoglobulin A

IgE:

Immunoglobulin E

IgG:

Immunoglobulin G

IgM:

Immunoglobulin M

INR:

International normalized ratio

IL-6:

Interleukin-6

JSH:

Japanese Society of Hepatology

LCA:

Lens culinaris agglutinin A

LDH:

Lactate dehydrogenase

LSEC:

Liver sinusoidal endothelial cell

M2BP:

Mac-2 binding protein

M2BPGi:

Mac-2-binding protein glycosylation isomer

MELD:

Model for end-stage liver disease

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

NAFLD:

Nonalcoholic fatty liver disease

PIIINP:

Procollagen type III N-terminal peptide

PBC:

Primary biliary cholangitis

PDD:

Pulse dye densitometer

Pro-C3:

N-terminal propeptide of type III collagen

PSC:

Primary sclerosing cholangitis

PT:

Prothrombin time

SRCR:

Scavenger receptor cysteine-rich domain

SVR:

Sustained virological response

T4C7S:

Type 4 collagen 7S

TIMP-1:

Tissue inhibitor of matrix metalloprotease-1

TIPS:

Transjugular intrahepatic portosystemic shunt

TNF-α:

Tumor necrosis factor-α

UDP:

Uridine diphosphate

WFA:

Wisteria floribunda agglutinin

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Authors and Affiliations

  1. Aichi, Japan

    Yoshio Sumida MD, PhD & Masashi Yoneda MD, PhD

  2. Osaka, Japan

    Yoshihiro Kamada MD, PhD

  3. Kyoto, Japan

    Masaki Iwai MD, PhD

  4. California, CA, USA

    Paul Y. Kwo MD

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  1. Yoshio Sumida MD, PhD
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  2. Yoshihiro Kamada MD, PhD
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  3. Masaki Iwai MD, PhD
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  4. Paul Y. Kwo MD
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  5. Masashi Yoneda MD, PhD
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Correspondence to Yoshio Sumida MD, PhD .

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Editors and Affiliations

  1. Department of Gastroenterology & Hepatology, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan

    Etsuko Hashimoto

  2. Department of Gastroenterology/Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA

    Paul Y. Kwo

  3. Department of Pathology and Laboratory Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, NH, USA

    Arief A. Suriawinata

  4. Department of Pathology, Caritas Medical Center, Kowloon, Hong Kong, China

    Wilson M.S. Tsui

  5. Division of Gastroenterology, Hepatology & Internal Medicine, Iwai Clinic, Kamigyo-ku, Kyoto, Japan

    Masaki Iwai

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Sumida, Y., Kamada, Y., Iwai, M., Kwo, P.Y., Yoneda, M. (2019). Laboratory Tests in Liver Diseases. In: Hashimoto, E., Kwo, P., Suriawinata, A., Tsui, W., Iwai, M. (eds) Diagnosis of Liver Disease. Springer, Singapore. https://doi.org/10.1007/978-981-13-6806-6_2

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