50,0.69), 0.65 (95% CI 0.54 0.74 respectively. In a smaller population of patients with ALD the predictive 4SC-202 datasheet performance of the ELF test has also shown AUC 0.80 (95% CI 0.70, 0.89) for liver related morbidity/mortality at 7 years (personal communication with Authors). Additional larger studies that can evaluate and compare performance of non invasive

methods in predicting clinical outcomes in patients with ALD are needed. In summary, none of the serum markers reported so far in the literature appear to have a very good performance for fibrosis severity less than moderate/severe fibrosis/cirrhosis. In general, performance 3-Methyladenine molecular weight decreases as severity of fibrosis being identified/ruled out decreases. HA shows some promise as a single marker in ruling out cirrhosis and to an extent severe fibrosis, but it is hard to know what threshold to use. Other single markers have less good performance when used alone. Some Panels (Fibrometer, Fibrotest Hepascore, and ELF) show promise in diagnosing cirrhosis/severe fibrosis but studies in ALD have small numbers. Conclusion A systematic evaluation of the evidence of the diagnostic performance of serum markers of fibrosis in ALD has shown that there are few small studies published which show that serum markers are able to identify cirrhosis/severe fibrosis with good diagnostic accuracy, although study heterogeneity in design and outcome precludes pooling. In

SB-715992 clinical practice, this may allow earlier exclusion of liver damage in hazardous drinkers permitting earlier and targeted interventions. The limitations of the liver biopsy may create a glass ceiling for potential non-invasive tests, and in this regard more studies using clinical outcomes should be evaluated. References 1. Breakwell C, Baker A, Griffiths C, Jackson click here G, Fegan G, Marshall D: Trends

and geographical variations in alcohol-related deaths in the United Kingdom, 1991–2004. Health Stat Q 2007, (33):6–24. 2. Leon DA, McCambridge J: Liver cirrhosis mortality rates in Britain, 1950 to 200226. Lancet 2006,367(9511):645.PubMedCrossRef 3. Bosetti C, Levi F, Lucchini F, Zatonski WA, Negri E, La VC: Worldwide mortality from cirrhosis: an update to 2002. J Hepatol 2007,46(5):827–839.PubMedCrossRef 4. Room R: British livers and British alcohol policy1. Lancet 2006,367(9504):10–11.PubMedCrossRef 5. Calling time; the nation’s drinking as a major health issue. London: Academy of Medical Sciences; 2004. 6. Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al.: Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002,97(10):2614–2618.PubMedCrossRef 7. Bedossa P, Dargere D, Paradis V: Sampling Variability of Liver Fibrosis in Chronic Hepatitis C. Hepatology 2003,38(6):1449–1457.PubMed 8. Rousselet MC, Michalak S, Dupre F, Croue A, Bedossa P, Saint-Andre JP, et al.: Sources of varialbility in histological scoring of chronic viral hepatitis. Hepatology 2005, 41:257–264.