We report for the first time the measurement of the serum concentration of the carboxy-terminal cross-linked telopeptide of type I collagen in patients with various liver diseases. This breakdown product of type I collagen, which is the major collagen type found in fibrotic liver, was measured by a radioimmunoassay in the serum of 149 patients with various liver diseases and in 67 controls. Its concentration is significantly elevated (P < 0.05) above reference intervals in sera from patients with liver diseases, except in patients with chronic active hepatitis of unknown origin and in patients with acute hepatitis A. In the 143 patients with liver fibrosis, the serum level of the carboxy-terminal telopeptide of type I collagen is correlated with the extent of fibrosis, as assessed by a histological scoring system (r = 0.3899, P < 0.0001), but not with inflammation and necrosis.