Steatosis affects the sensitivity but not the specificity of non‐invasive fibrosis tests in non‐alcoholic fatty liver disease – implications for screening strategies

Zakeri, Nekisa; Tsochatzis, Emmanuel

doi:10.1111/liv.13602

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Since 75 % (n. 300) of the studied population is composed of patients with NAFLD, an important aspect emerging from the present study is the impact of liver steatosis and high BMI on liver stiffness assessment. Several studies demonstrated that severe liver steatosis affects liver stiffness assessed by F-TE, resulting in an overestimate of fibrosis [25]. For this reason new F-TE cut-off values have been proposed in the presence of a CAP > 300 dB/m [26][27][28][29][30].…”

Section: (95 % Ci)mentioning

confidence: 99%

Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

et al. 2019

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Purpose ElastPQ is a new elastography technique for non-invasive liver fibrosis staging. However, it does not have validated reliability criteria. We tested the reliability of a different number of measurements in patients with chronic liver disease and explored whether the application of quality criteria improves the diagnostic performance. Materials and Methods All patients underwent liver stiffness assessment (LSM) with ElastPQ and Fibroscan (F-TE). The mean, median, standard deviation (SD) and interquartile range (IQR) of 10, 5 and 3 measurements were retrospectively collected for each patient and compared to each other. Liver histology was available in a subset of patients. Results Overall, 400 patients met the inclusion criteria. Non-alcoholic fatty liver disease (NAFLD) was the most represented etiology (75 %), followed by primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH). The correlation of medians was significantly better between 10 and 5 measurements than between 10 and 3. The difference of medians was significant only in the comparison between 10 and 3 measurements. The correlation between ElastPQ and F-TE was equally good for 10 and 5 measurements and significantly improved after an IQR/median ≤ 30 % was applied. The diagnostic performance of ElastPQ was better with the median value of 10 and 5 measurements and improved if LSM values were obtained with IQR/M ≤ 30 %. Conclusion The median value of 5 valid LSMs suffices for the reliable estimation of liver stiffness using ElastPQ. The quality criterion of IQR/M ≤ 30 % should also be followed when using this technique.

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Section: (95 % Ci)mentioning

confidence: 99%

Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

et al. 2019

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“…2 Of note, the NFS is a low-sensitivity/high-specificity screening tool. 3 Consequently, it can confidently rule out the presence of advanced fibrosis in patients with NAFLD with a score < −1.455, but it is unable to make a reliable diagnosis of advanced fibrosis in those with a score >0.676. 3 In order to conduct a more meaningful analysis, the author should divide the study patients (n = 159) into the 3 abovementioned NFS categories and report the SYNTAX score values in these risk groups.…”

mentioning

confidence: 99%

“…3 Consequently, it can confidently rule out the presence of advanced fibrosis in patients with NAFLD with a score < −1.455, but it is unable to make a reliable diagnosis of advanced fibrosis in those with a score >0.676. 3 In order to conduct a more meaningful analysis, the author should divide the study patients (n = 159) into the 3 abovementioned NFS categories and report the SYNTAX score values in these risk groups. However, we cannot exclude that the study by Turan 1 could be underpowered to conduct such an analysis because, in general, only 5% of all screened patients fall into the high-risk category.…”

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confidence: 99%

NFS Is Not a Marker of Nonalcoholic Fatty Liver Disease Per Se: What Is the True Relationship With CAD Complexity?

Yılmaz

Eren

2019

Angiology

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Etiology and Severity of Liver Disease in HIV-Positive Patients With Suspected NAFLD: Lessons From a Cohort With Available Liver Biopsies

Prat

Roccarina

Lever

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Spectrum of liver injury among HIV-positive people is wide; in particular, prevalence of nonalcoholic fatty liver disease (NAFLD) seems to be higher compared with HIV-negative people. Methods: We retrospectively evaluated all liver biopsies performed at Royal Free Hospital from 2000 to 2017 in HIV monoinfected patients with abnormal transaminases, to assess the underlying cause of liver disease and to characterize the extent of fibrosis. We furthermore evaluated the diagnostic accuracy of FIB4 and FibroScan as noninvasive tools for fibrosis assessment. Results: Ninety-seven patients were included. Most common histological findings were NAFLD (28%), nonspecific changes (26%), and normal histology (13%). Twenty percent of the patients had significant fibrosis and 11% had advanced fibrosis. FIB4, at a cutoff of 1.3, had a specificity of 82% and negative predictive value (NPV) of 95% for exclusion of advanced fibrosis. FibroScan was available in 28% patients and 33% had a liver stiffness ≥7.5 kPa. FibroScan showed a specificity of 77% and NPV of 94% for exclusion of significant fibrosis. Among patients with NAFLD (n = 27), 18% had advanced fibrosis, whereas the majority (56%) did not have any fibrosis. The NPV of FIB4 for advanced fibrosis in these patients was 93%. Conclusions: Among HIV-positive patients with elevated transaminases, a surprisingly high number of patients had nonsignificant changes or even normal histological findings. The prevalence of NAFLD was lower than reported in other series. Use of noninvasive tools with a high NPV for significant fibrosis can help reduce the number of required biopsies.

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Steatosis affects the sensitivity but not the specificity of non‐invasive fibrosis tests in non‐alcoholic fatty liver disease – implications for screening strategies

Abstract: See Article on Page 331

Cited by 5 publications

References 14 publications

Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

Establishing Reliability Criteria for Liver ElastPQ Shear Wave Elastography (ElastPQ-SWE): Comparison Between 10, 5 and 3 Measurements

NFS Is Not a Marker of Nonalcoholic Fatty Liver Disease Per Se: What Is the True Relationship With CAD Complexity?

Etiology and Severity of Liver Disease in HIV-Positive Patients With Suspected NAFLD: Lessons From a Cohort With Available Liver Biopsies

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