What is the situation with blood tests for fatty liver disease today?
The table above was produced by Fibronostics. We have followed the development of their program for a couple of years and they are supporters of the foundation. The thing that caught my attention back in 2018 was that their test, like the earlier Fibrosure was the result of artificial intelligence studies. A lot of AI is being done today but those two were early developers and I felt that this would be the future for us as patients. The downside, of course, is that tests like these are proprietary so the costs are higher so the question of who should use them is more complicated. For me, as a patient, I wish such tools had been available to me early on in my disease so that I might not have ended up as a cirrhotic.
You may remember a blog I wrote a few months ago when I had the LIVERFASt test run on me. My interest was whether I could use it to monitor my situation from now on. For those of you who missed that blog, these were my results. You can see that it shows a lot of fibrosis but no NASH activity and no liver fat.
Several blood based tests are coming online now and we are on the brink of being able to talk about the "old days" when cirrhosis came as a surprise. The table compares tests that we are currently examining. Some of these are old, like the FIB-4, and there are others on the way like ProC3 but this will give you a sense of things we have today. Evidence that these are becoming main stream is that Medicare will now cover the newer advanced tests like LIVERFASt and Fibrosure.
Liver biopsy is still the gold standard used in research to characterize liver disease. That is not a useful tool for the typical patient which leaves us with a great need for effective blood tests that can be used in a normal patient situation. In recent years tremendous progress has been made in the development of tests so I thought you might like a snapshot of where we are today with blood tests.
Historically, elevated liver enzymes of ALT, AST, and GGT were typical signals that prompted doctors to consider advancing liver disease. Those have proven to be very unsatisfactory as many patients first learn of their liver disease by being told that they have cirrhosis. A key mission of the Foundation is to promote early screening for liver disease so that patients need not develop end stage disease.
I have been able to manage my disease and essentially stop the progression of NASH. Some of you will recall that my Fibroscan score at diagnosis was 21.5. That was a scary F4/cirrhosis. Today it is 9.6 which is a far more manageable F2/F3. I certainly still have the scarring but I don't have active disease and I don't have any fat in my liver as shown by 3 biopsies. This is the chart of my liver stiffness over time.
Since these have also been verified by biopsy my scores on the LIVERFASt test quite accurately track my known condition. My personal plan is to use these new tests to monitor my status in coming years. I'm sure they will improve these over time but for now this is a great leap forward.
You can see by looking at the table above that most of the older tools provide more limited information. They have their uses and do provide value but I really like the detail of the more complex tests as a guide for me personally. I plan to use these advanced blood tests from time to time to keep track of my liver status. I hope to do it as part of my routine 6 month monitoring for HCC. Testing like this isn't appropriate for everyone, but I'm a data nerd and I want to know as much as possible about my situation so it works for me.
We hope that you and yours are safe and as well as you can be in this very stressful time.