Chen T, Zhou K, Sun T, et al. - This study not only unveiled stage-specific bile acid (BA) perturbation patterns but also offered new biomarkers as well as tools for the monitoring of liver disease progression.

• Study participants were 1,883 in total, including healthy controls and chronic liver disease (CLD) patients (non-alcoholic fatty liver [NAFL], non-alcoholic steatohepatitis [NASH], fibrosis, cirrhosis, and three types of liver cancer), in whom 15 BAs were quantified.

• Experts calculated five BA glycine : taurine ratios, and found glycocholic acid/taurocholic acid, glycodeoxycholic acid/taurodeoxycholic acid, and glycochenodeoxycholic acid/taurochenocholic acid as candidates.

• They developed three diagnostic models for distinguishing healthy control and early CLD (NAFL + NASH), early and advanced CLD (fibrosis + cirrhosis + liver cancer), and NAFL and NASH, respectively.

• The models-generated areas under the receiver operating characteristic curve ranged from 0.91 to 0.97.

• Further improvement of model performances was achieved by adding age and gender.

• In independent test sets (n = 291), the changes of the candidates and the performances of the diagnostic models were successfully validated.