Hepatology

Non-invasive liver fibrosis assessment

Chronic liver disease staging has shifted from biopsy-dependent to non-invasive assessment. The FIB-4 index and AST-to-Platelet Ratio Index (APRI) are validated serum-based fibrosis markers that reliably exclude advanced fibrosis (F3-F4) in NAFLD and viral hepatitis, reducing the need for liver biopsy by approximately 50%.

Cirrhosis prognosis and transplant prioritization

Cirrhosis prognosis and transplant prioritization are determined by the Model for End-Stage Liver Disease (MELD) score, which incorporates bilirubin, INR, and creatinine to predict 90-day mortality. The MELD-Na variant adds serum sodium for improved prediction. The Child-Pugh score (CTP) classifies cirrhosis severity into Class A, B, or C for prognostic assessment and surgical risk stratification.

Alcoholic hepatitis severity and treatment response

Alcoholic hepatitis severity is assessed by the Maddrey Discriminant Function (DF) and the Lille Model, which guide the decision for corticosteroid therapy. A Lille score of >0.45 identifies non-responders who derive no benefit from continued steroid treatment, enabling early discontinuation to reduce infection risk.