3. Serum levels are affected by clearance rates, which may be impaired either due to sinusoidal endothelial cell dysfunction or impaired biliary excretion
(for details, see Friedman SL, Mount Sinai School of Medicine, www.uptodate.com/patient_info/topicpages/topics/Cirrhosi/9999.asp#13). While their accuracy and predictive value of non-invasive markers are improving, they cannot yet supplant direct analysis of liver. Individual serum fibrosis markers have limited accuracy in predicting hepatic fibrosis [49]. Indices composed of a panel of markers correlate better with histological fibrosis, but their reliability requires further validation [49, 69]. They can indicate tendency of hepatic fibrosis, but it cannot replace liver biopsy. There remains a compelling need for more of the efficient noninvasive markers that in combinations, by complex scoring, would accurately reflect the biochemistry of liver function and matrix content of tissue and, thus, have a better prognostic accuracy than standard clinical and laboratory indices.