New sequential combinations of non-invasive fibrosis tests provide an accurate diagnosis of advanced fibrosis in NAFLD

Boursier, Jérôme; Guillaume, Maéva; Leroy, Vincent; Irlès, Marie; Roux, Marine; Lannes, Adrien; Foucher, Juliette; Zuberbuhler, Floraine; Delabaudière, Cyrielle; Barthelon, Justine; Michalak, Sophie; Hiriart, Jean‐Baptiste; Péron, Jean‐Marie; Gerster, Théophile; Bail, Brigitte Le; Riou, Jérémie; Hunault, Gilles; Merrouche, Wassil; Oberti, Frédéric; Pelade, Laurence; Fouchard, Isabelle; Bureau, Christophe; Calès, Paul; Lédinghen, Victor de

doi:10.1016/j.jhep.2019.04.020

Cited by 114 publications

(147 citation statements)

References 30 publications

Supporting

Mentioning

136

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, NAFLD imposes excess risk of cardiovascular diseases (CVD), the leading cause of poor prognosis among the patients. Currently, liver fibrosis is considered as the main indicator of prognosis in NAFLD . The presence of advanced fibrosis was associated with increased risk of liver‐related and overall mortality .…”

Section: Introductionmentioning

confidence: 99%

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Xin

Zhu

Wang

et al. 2019

Liver International

View full text Add to dashboard Cite

Background & Aims Nonalcoholic fatty liver disease (NAFLD) has been considered as a risk factor of adverse cardiovascular prognosis, but the relationship between subclinical atherosclerosis and NAFLD remains controversial. We aimed to investigate the impact of subclinical atherosclerosis on incident NAFLD and liver fibrosis. Methods We included 3433 subjects aged ≥40 years and free of NAFLD. Brachial‐ankle pulse wave velocity (ba‐PWV) and carotid intima‐media thickness (CIMT) were measured at baseline to assess subclinical atherosclerosis status. At follow‐up visit, NAFLD was diagnosed by hepatic ultrasound and fibrosis was assessed by NAFLD fibrosis score (NFS), fibrosis‐4 score (FIB‐4) and aspartate aminotransferase to platelet ratio index (APRI). Results A total of 654 (19.1%) subjects developed NAFLD during the follow‐up period of 4.3 years. In the multivariate logistic regression models, each standard deviation (SD) increment of ba‐PWV was associated with 20% (95% confidence interval [CI] 1.07‐1.33), 22% (95% CI 1.08‐1.39), 17% (95% CI 1.04‐1.32) and 37% (95% CI 1.07‐1.75) higher risk of incident NAFLD, higher NFS, FIB‐4 and APRI respectively. Compared with the lowest quartile of ba‐PWV, the highest quartile ba‐PWV had 63% (95% CI 1.20‐2.22), 112% (95% CI 1.42‐3.17), 86% (95% CI 1.28‐2.69) and 201% (95% CI 1.29‐7.04) higher risk of incident NAFLD, higher NFS, FIB‐4 and APRI respectively. Besides, per SD increase of CIMT was associated with a 12% (95% CI 1.01‐1.24) higher risk of incident NAFLD. Conclusions Increased ba‐PWV was independently associated with incident NAFLD and higher probability of fibrosis, whereas CIMT was associated with incident NAFLD but not with fibrosis.

show abstract

Section: Introductionmentioning

confidence: 99%

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Xin

Zhu

Wang

et al. 2019

Liver International

View full text Add to dashboard Cite

show abstract

“…The FibroMeter tests include the FibroMeter VCTE which is a combination of blood markers with the Fibroscan result (Echosens) in a single formula (Table S1 and Table ). Recent studies have demonstrated that the combinatory FibroMeter VCTE outperforms blood fibrosis tests and Fibroscan for the non‐invasive evaluation of liver fibrosis in NAFLD . Used as second‐line procedure after blood fibrosis tests or Fibroscan, the FibroMeter VCTE decreases the rate of patients with undetermined diagnosis by twofold …”

Section: Discussionmentioning

confidence: 99%

“…All patients provided their informed written consent before participating in the study. Some of the patients included in the present study were part of two previously published works: 163 patients in the SNIFF72 study and 370 patients in the SNIFF89 study …”

Section: Methodsmentioning

confidence: 99%

Direct comparison of the specialised blood fibrosis tests FibroMeter^V2G and Enhanced Liver Fibrosis score in patients with non‐alcoholic fatty liver disease from tertiary care centres

Guillaume

Moal

Delabaudière

et al. 2019

Aliment Pharmacol Ther

Self Cite

View full text Add to dashboard Cite

Summary Background The Enhanced Liver Fibrosis score (ELF) and the FibroMeterV2G are two specialized blood fibrosis tests which include direct markers of liver fibrosis. They have been shown to be more accurate than the simple blood fibrosis tests FIB4 and the non‐alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Aims To directly compare the accuracies of ELF and FibroMeterV2G for the non‐invasive diagnosis of liver fibrosis in NAFLD. Methods Four hundred and seventeen patients with biopsy‐proven NAFLD were enrolled from two tertiary care centres. Four blood fibrosis tests were calculated: ELF, FibroMeterV2G, NFS, and FIB4. Advanced fibrosis F3/4 on liver biopsy (NASH CRN scoring) was the primary endpoint. Results Areas under the receiver operating characteristic (AUROC) curve for advanced fibrosis were not significantly different between the direct markers of liver fibrosis (hyaluronate, PIIINP, TIMP‐1, alpha2‐macroglobulin) and the simple blood fibrosis tests NFS and FIB4. ELF (0.793 ± 0.022) and FibroMeterV2G (0.804 ± 0.021) had significantly higher AUROC than NFS (0.722 ± 0.025, P < .010) and FIB4 (0.739 ± 0.024, P < .020). AUROC for advanced fibrosis and Obuchowski index were not significantly different between ELF and FibroMeterV2G. Algorithms using first ELF or FibroMeterV2G and then liver biopsy in case of undetermined diagnosis provided high diagnostic accuracy for advanced fibrosis: 90% sensitivity, 90% specificity, 93% negative predictive value, 85% positive predictive value, and 90% correct classification. In these algorithms, the rate of liver biopsy was 45.3% with ELF versus 39.3% with FibroMeterV2G (P = .065). Conclusions ELF and FibroMeterV2G have equal accuracy and perform better than the simple FIB4 and NFS tests for the non‐invasive diagnosis of advanced liver fibrosis in patients with NAFLD from tertiary care centres.

show abstract

“…It should be kept in mind that FIB‐4 and NFS do not adequately rule‐in advanced fibrosis (with a high rate of false‐positive results), thus further assessment with a more specific test is required in case of positive results. Several tests have been proposed for these cases, including ELF TM , Fibrometer® and TE . For instance, in a large, prospective study of a UK primary care referral pathway in 1,452 patients with NAFLD, Srivastava et al recently showed that a two‐step pathway (FIB‐4 followed by ELF TM performed in those with an indeterminate (score 1.3‐3.25) FIB‐4) reduced unnecessary referrals to liver specialists by 81%, and also markedly increased (five‐fold) the accurate referral of cases with advanced fibrosis.…”

Section: Referral Pathways From Primary Healthcare/diabetes Clinics Tmentioning

confidence: 99%

Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics

Castéra

2020

Liver International

View full text Add to dashboard Cite

Despite affecting around one‐fourth of the general population worldwide, non‐alcoholic fatty liver disease (NAFLD) remains a largely under‐recognized disease in primary healthcare, with not more than 10% of patients diagnosed with NAFLD referred to specialists. The main challenge in clinical practice is the identification of those with advanced liver fibrosis or cirrhosis, as they are at the greatest risk of developing complications. Liver biopsy appears to be an unrealistic and unsuitable option because of the large number of high‐risk patients and the well‐known limitations of this technique. This has favoured the development of non‐invasive tests, which have been an area of intensive research in the past decade. Transient elastography, FIB‐4 and the NAFLD fibrosis score are the most extensively used and best validated tests, with summary AUROC values for detecting advanced fibrosis in NAFLD patients of 0.88, 0.84 and 0.84 respectively. Although much work remains to be done to establish cost‐effective strategies for the screening for advanced fibrosis, the sequential use of non‐invasive tests (serum biomarkers, then measurement of liver stiffness using transient elastography) appears to be the most promising strategy. The next step is to establish effective pathways in primary healthcare and/or diabetes clinics where most NAFLD patients are seen, to identify those who need to be referred to liver clinics for further assessment.

show abstract

New sequential combinations of non-invasive fibrosis tests provide an accurate diagnosis of advanced fibrosis in NAFLD

Abstract: NFS threshold: -1.455 in patients <65 years old, 0.12 in patients ≥65 years old # FIB4 threshold: 1.30 in patients <65 years old, 2.0 in patients ≥65 years old

Cited by 114 publications

References 30 publications

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Direct comparison of the specialised blood fibrosis tests FibroMeter^V2G and Enhanced Liver Fibrosis score in patients with non‐alcoholic fatty liver disease from tertiary care centres

Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics

Contact Info

Product

Resources

About

New sequential combinations of non-invasive fibrosis tests provide an accurate diagnosis of advanced fibrosis in NAFLD

Abstract: NFS threshold: -1.455 in patients <65 years old, 0.12 in patients ≥65 years old # FIB4 threshold: 1.30 in patients <65 years old, 2.0 in patients ≥65 years old

Cited by 114 publications

References 30 publications

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Associations of subclinical atherosclerosis with nonalcoholic fatty liver disease and fibrosis assessed by non‐invasive score

Direct comparison of the specialised blood fibrosis tests FibroMeterV2G and Enhanced Liver Fibrosis score in patients with non‐alcoholic fatty liver disease from tertiary care centres

Non‐invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics

Contact Info

Product

Resources

About

Direct comparison of the specialised blood fibrosis tests FibroMeter^V2G and Enhanced Liver Fibrosis score in patients with non‐alcoholic fatty liver disease from tertiary care centres