Performance of Biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in Patients with Severe Obesity: Meta Analysis of Individual Patient Data

Abstract

BackgroundLiver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.Methods494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.ResultsPrevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance) = 0.85 (0.83–0.87; P<0.0001); SteatoTest for advanced steatosis = 0.80 (0.79–0.83); and ActiTest for steato-hepatitis = 0.84 (0.82–0.86; P<0.0001). Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63–0.79; P<0.0001); SteatoTest = 0.71 (0.66–0.75; P<0.0001); and ActiTest = 0.74 (0.68–0.79; P<0.0001). Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.ConclusionIn patients with severe obesity, a significant diagnostic performance of FibroTest, SteatoTest and ActiTest was observed for liver lesions.

Non-invasive assessment of fatty liver

“…Poynard és mtsai a Steatotestet a NAS pontrendszerrel hasonlították össze. A SteatoTest pozitív prediktív értéke (PPÉ) 92,4%-osnak mutatkozott a steatosis (>S0) kimutatásában (0,38 cutoff), és 59,3%-os negatív prediktív értéket (NPÉ) közöl-tek az S1-nél súlyosabb steatosis kimutatásában (0,69 cutoff) [46].…”

“…Poynard és mtsai vizsgálatai alapján a steatohepatitis kórisméjének felállításához az ActiTest negatív prediktív értéke 96,0% (NAS>4, 0,29 cutoff), és a NASH súlyosságának elkülö-nítéséhez az AT-pozitív prediktív értéke (NAS>2) 47,5% (0,17 cutoff) volt [46].…”

“…Az érzékenysége a steatohepatitis kimutatásában 92,9% (NAS>2, cutoff 0,5), fajlagossága 95,8% az előrehaladott NASH (NAS>4) kimutatásában (cutoff 0,7) [46].…”

“…A nem invazív pontrendszerek alkalmasak lehetnek nagy kockázatú egyénekben (hyperlipidaemia, diabetes mellitus) a májelzsírosodás szűrésére (3. táblázat) [46,47].…”

Arterial hypertension, obesity and non-alcoholic fatty liver disease: is there any connection?

“…Taking into account the lack of a clear clinical picture in the early stages of its development, NAFLD diagnosis is often carried out during the aimed examination of patients with obesity and hypertension (EH), their combination or other diseases [37,38]. So, it is difficult to estimate its real prevalence in the population [37,[39][40][41][42][43][44][45]. To date, the gold standard of NAFLD diagnosis remains the tissue biopsy and biopsy scales, the most common of which is semi-quantitative NA-FLD rating scale (NAS) [43].…”