Accuracy of non-invasive liver stiffness measurement and steatosis quantification in patients with severe and morbid obesity

Abstract

Background: Vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP™) have shown reliable performance predicting fibrosis and steatosis in normal-to overweight patients but have not been validated in severe to morbid obesity. This study aimed at determining the accuracy of VCTE, CAP™ and the composite score FibroScan-AST (FAST) in patients with a body mass index (BMI) of ≥35 kg/m². Methods: Patients scheduled for bariatric-metabolic surgery underwent preoperative VCTE/CAP™ measurement, and intraoperative liver biopsy. The feasibility and accuracy of VCTE, CAP™ and the composite score FAST were retrospectively analysed to evaluate fibrosis, steatosis and active fibrotic nonalcoholic steatohepatitis [NASH + non-alcoholic fatty liver disease (NAFLD) activity score ≥4 + fibrosis grade ≥2] using per protocol (PP) and intent to diagnose (ITD) calculation.Results: In total, 170 patients (median BMI 44.4 kg/m²) were included in the study. Liver biopsy showed NASH, simple steatosis, and normal livers in 60.6% (n=103), 28.8% (n=49), and 10.6% (n=18), respectively. VCTE and CAP™ delivered reliable results in 90.6% (n=154/170) and 90.5% (n=134/148). The AUC (PP) of VCTE, CAP™, and FAST were 0.687 (≥F2), 0.786 (≥F3), 0.703 (≥S2), 0.738 (S3), and 0.780 (active fibrotic NASH). The AUC increased to 0.742 (≥F2), 0.842 (≥F3), 0.712 (≥S2), 0.780 (S3), and 0.836 (active fibrotic NASH) in patients below the median BMI of 44.4 kg/m². Conclusions: VCTE, CAP™ and FAST show acceptable accuracy for the detection of fibrosis, steatosis and NASH in a real-life cohort of patients with obesity. Accuracy improves in patients with a BMI <44.4 kg/m 2 .

Metastasis of papillary thyroid cancer: does body mass index (BMI) is the key factor?

“…And a meta-analysis ( 5 ) which involved 26,196 participants carried out by Renehan et al also descripted that elevated body mass index (BMI) was significantly associated with ETE and multifocality in overweight and obese patients and only obesity was significantly associated with increased tumor size. The same effect can also be seen in many studies ( 6 , 7 ). Therefore, the aggressiveness of PTC may associated with the increase of BMI, so it is necessary to divide overweight and obese patients in different groups.…”

Associations between serum biomarkers and non-alcoholic liver disease: Results of a clinical study of Mediterranean patients with obesity

“…CAP estimates the degree of ultrasound attenuation due to hepatic fat at the standardized frequency of 3.5 MHz by vibration-controlled transient elastography (VCTE), implemented as FibroScan transient elastography (Echosens, Paris, France) ( 25 ). Data trials in patients with obesity suggest that CAP measured with FibroScan is comparable to liver biopsy for the detection and quantification of steatosis ( 26 ). NAFLD was diagnosed if CAP exceeded 302 dB/m, previously identified as the optimal cutoff for an accurate diagnosis of ≥5% hepatic steatosis using the Youden index, with a sensitivity of 0.80 (95% confidence interval [CI], 0.75–0.84) and specificity of 0.83 (95% CI, 0.69–0.92) ( 18 ).…”

Non-alcoholic Fatty Liver Disease and Depression: Evidence for Genotype × Environment Interaction in Mexican Americans

“…The BDI-II assesses the severity of depression and is an acceptable screening instrument for depression when administered in both Spanish and English (35)(36)(37). We measured hepatic fibrosis reported as the LSM Youden Index (kPa) and analyzed it as a continuous variable (Echosens, Paris, France) (13,38,39). Participants were excluded from elastography if they were pregnant, had an implant, or had a pacemaker.…”