The amino-terminal procollagen type III propeptide has also been studied. These different markers are found in the blood and have been correlated with the development of hepatic fibrosis.25 Several studies have

shown that serum laminin levels are significantly correlated with HVPG values in patients with hepatic fibrosis High Content Screening and in patients with cirrhosis.26-28 However, the prediction of severe portal hypertension or esophageal varices by laminin levels was poor with a positive predictive value of 85% and a negative predictive value of 43%.28 Similar correlations were found between the serum hyaluronic acid concentrations and the HVPG.29 On the other hand, serum levels of the amino-terminal procollagen type III propeptide were poorly correlated with the HVPG in patients with cirrhosis, but they were correlated with hepatic fibrosis.27, 30 The results for these

different biochemical markers are important but suggest that these markers cannot be currently used to detect the presence of severe portal hypertension. At the same time, these selleckchem studies were performed with small groups of patients, and new investigations with larger groups including patients with asymptomatic cirrhosis could help us to determine patients with severe portal hypertension as well as patients at risk of complications. The second type of marker is FibroTest, a panel of biochemical markers of hepatic fibrosis that has been extensively validated. In one prospective study, 130 patients with or without cirrhosis were included to determine whether

FibroTest could diagnose severe portal hypertension.31 There was a significant correlation between FibroTest values and HVPG values, but this correlation was weaker in patients with cirrhosis. Although the FibroTest value was significantly higher in patients with severe portal hypertension, the area under the receiver operating characteristic curve for the diagnosis of severe portal hypertension was only 0.79. Thus, other studies are needed to confirm these results, especially in patients with nondecompensated cirrhosis. Different pheromone noninvasive markers or combinations of markers have also provided good results for the evaluation of hepatic fibrosis. Studies on portal hypertension are ongoing.32 These biochemical markers have the advantage of noninvasive and easily available blood tests and are, therefore, potentially interesting for screening. Moreover, FibroTest correlates with mortality in patients who are inactive hepatitis B virus carriers.33 In particular, the prognostic value of FibroTest is higher than the prognostic value of the viral load or alanine aminotransferase. These biochemical markers must be validated in large samples for the diagnosis of portal hypertension to confirm the results obtained in pilot studies.