Summary
Background and aims
Sarcopaenia is associated with advanced nonalcoholic fatty liver disease (NAFLD). However, the impact of the muscle mass categorised by muscle quality on fibrosis progression remains unclear.
Methods
A total of 292 patients with biopsy‐proven NAFLD who underwent serial vibration‐controlled transient elastography assessments at least 1 year from baseline were selected. The skeletal muscle area (SMA) was determined on abdominal computed tomography (CT) at the third lumbar vertebra level and categorised to normal‐attenuation muscle area (NAMA), low‐attenuation muscle area (LAMA) and intermuscular adipose tissue (IMAT) using a muscle quality map. These SMAs were normalised by the height squared to obtain the skeletal muscle index (SMI).
Results
At baseline, as the histological fibrosis stage increased, SMINAMA decreased and SMILAMA increased (p for trend = 0.014 and p for trend <0.001, respectively), which was not significant after adjustment for age, sex and obesity. During a median follow‐up of 41 months, fibrosis progression was detected in 48 out of 292 patients, and higher SMILAMA quartiles independently increased the risk of fibrosis progression in a dose‐dependent manner (hazard ratio [HR] per quartile: 1.41; 95% confidence interval [CI], 1.04–1.91). The highest quartile of SMILAMA increased the risk of fibrosis progression by 3.25 times compared to the lowest quartile of SMILAMA (95% CI, 1.18–8.90). SMINAMA quartiles were not associated with the risk of fibrosis progression.
Conclusion
Increased low‐quality muscle mass, but not decreased normal‐quality muscle mass, as assessed by a muscle quality map in CT, predicts fibrosis progression in patients with NAFLD.
Summary
Background and Aims
Vibration‐controlled transient elastography (VCTE) has shown good diagnostic performance in predicting fibrosis stages in patients with non‐alcoholic fatty liver disease (NAFLD). However, an optimal diagnostic approach to detect advanced fibrosis in patients with NAFLD has not been established.
Approach and Results
We prospectively collected data from 539 subjects who underwent liver biopsy at a single centre between January 2014 and December 2019. Diagnostic performance was estimated using the area under the receiver‐operating characteristic curve (AUROC). Several models combining the fibrosis 4 index (FIB‐4) score and liver stiffness measurement (LSM) were analysed to reduce the need for unnecessary liver biopsies. We observed significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) in 173 (32.1%), 74 (13.7%) and 46 subjects (8.5%), respectively. The AUROCs (95% CI) for LSMs to diagnose ≥F2, ≥F3 and F4 were 0.82 (0.78‐0.85), 0.92 (0.89‐0.94) and 0.95 (0.93‐0.97), respectively. Optimal LSM cut‐off values were 6.7 (≥F2), 8.3 (≥F3) and 9.8 (F4) kPa. LSMs were affected by waist circumference, serum albumin and fibrosis stage (R2 = 0.315). Abdominal obesity, elevated transaminase, diabetes mellitus and high IQR/Median were associated with the discordance of ≥2 fibrosis stages between LSMs and histologic data. The sequential use of the age‐adjusted FIB‐4 and LSMs yielded the least uncertainty (5.3%) in classifying disease severity with the highest diagnostic accuracy (81%) among a variety of non‐invasive test combinations.
Conclusions
The sequential approach of age‐adjusted FIB‐4 and VCTE could represent a practical diagnostic strategy to detect advanced fibrosis in NAFLD (http://ClinicalTrials.gov #NCT 02206841).
LINKED CONTENT
This article is linked to Lee et al papers. To view these articles, visit https://doi.org/10.1111/apt.17601 and https://doi.org/10.1111/apt.17618
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