Performance of the Bard Scoring System in Bariatric Surgery Patients with Nonalcoholic Fatty Liver Disease

Nassif, André Thá; Nagano, Thais Ayumi; Okayama, Sulamita; Nassif, Luis Sérgio; Filho, Alcides Branco; Neto, José Sampaio

doi:10.1007/s11695-016-2284-z

Cited by 9 publications

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the other composite scores, the suggested cutoff of 1.0 for APRI resulted in high specificity but poor sensitivity, making it useful only as a rule-in test ( 45 ). BARD had the lowest AUROC and had low specificity, mirroring previous findings in obese individuals ( 21 ). These considerations support use of ADAPT or the inexpensive FIB-4, which has limitations regarding its use of 2 cutoffs, as first-line tests in obese individuals.…”

Section: Discussionsupporting

confidence: 85%

Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease

Qadri

Ahlholm

Lønsmann

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

Context Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity. Objective To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD. Design Cross-sectional cohort study comparing simple fibrosis scores (FIB-4, NFS, APRI, BARD, HFS) and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or CK-18 (MACK-3). Setting Tertiary referral center. Patients We recruited overweight/obese patients from endocrinology (n=307) and hepatology (n=71) clinics undergoing a liver biopsy (median BMI 40.3 [IQR 36.0–44.7] kg/m 2). Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cut-offs for NFS. Main Outcome Measures Biomarker AUROC, sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis (fibrotic NASH). Results The scores with an AUROC >0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cut-offs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs <30.0, 30.0–39.9, and ≥40.0 kg/m 2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis. Conclusions In obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cut-offs.

show abstract

Section: Discussionsupporting

confidence: 85%

Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease

Qadri

Ahlholm

Lønsmann

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

show abstract

“…The general profile of the patients was as expected for a population that undergoes bariatric surgery through the Brazilian Unified National Health System (SUS): 91.36% female, average age was 45.55 years and average prior BMI was 42.93 kg/m². The low proportion of SG (12.35%) compared to RYGB is also found at SUS 14,15 .…”

Section: Discussionmentioning

confidence: 79%

Incisional Hernioplasty Techniques: Analysis After Open Bariatric Surgery

Nassif

Nagano

Villela³

et al. 2020

ABCD, arq. bras. cir. dig.

Self Cite

View full text Add to dashboard Cite

Background: The best technique for incisional hernioplasty has not been established yet. One of the difficulties to compare these techniques is heterogeneity in the profile of the patients evaluated. Aim: To analyze the results of three techniques for incisional hernioplasty after open bariatric surgery. Method: Patients who underwent incisional hernioplasty were divided into three groups: onlay technique, simple suture and retromuscular technique. Results and quality of life after repair using Carolina’s Comfort Scale were evaluated through analysis of medical records, telephone contact and elective appointments. Results: 363 surgical reports were analyzed and 263 were included: onlay technique (n=89), simple suture (n=100), retromuscular technique (n=74). The epidemiological profile of patients was similar between groups. The onlay technique showed higher seroma rates (28.89%) and used a surgical drain more frequently (55.56%). The simple suture technique required longer hospital stay (2.86 days). The quality of life score was worse for the retromuscular technique (8.43) in relation to the onlay technique (4.7) and the simple suture (2.34), especially because of complaints of chronic pain. There was no difference in short-term recurrence. Conclusion: The retromuscular technique showed a worse quality of life than the other techniques in a homogeneous group of patients. The three groups showed no difference in terms of short-term hernia recurrence.

show abstract

“…Positive predictive values were progressively lower as higher scores were assigned (VLS 0-1 = 68.59% preperfusion and 68.8% postperfusion; VLS 2-3 = 33.82% preperfusion and 32% postperfusion; VLS ≥4 = 3.7% preperfusion and 3.12% postperfusion), suggesting a trend toward overrating the severity of NAFLD when there is a worse perception of macroscopic findings. 23 Although the VLS was proposed to increase the ectoscopy precision when evaluating NAFLD, incorrect analysis of severity was still frequent, with the immediate result of organ disposal; all 4 evaluators classified viable grafts as unviable at some point (preperfusion or postperfusion). This is the same obstacle faced when a nonstandardized visual analysis is performed.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation

Sampaio-Neto,

Nicoluzzi,

Luvison Gomes da Silva

et al. 2023

Transplantation Direct

View full text Add to dashboard Cite

Background. The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns. Methods. Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated. Results. Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS. Conclusions. Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.

show abstract

Performance of the Bard Scoring System in Bariatric Surgery Patients with Nonalcoholic Fatty Liver Disease

Abstract: The BARD score is still not ideal for the diagnosis of nonalcoholic fatty liver disease, hepatitis, and fibrosis, but it was proved to be effective in the detection of absence of liver fibrosis in a bariatric population.

Cited by 9 publications

References 25 publications

Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease

Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease

Incisional Hernioplasty Techniques: Analysis After Open Bariatric Surgery

Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation

Contact Info

Product

Resources

About