Steatosis severity affects the diagnostic performances of noninvasive fibrosis tests in nonalcoholic fatty liver disease

Joo, Seung Ki; Kim, Won; Kim, Dong‐Hee; Kim, Jung Ho; Oh, Sohee; Lee, Kook Lae; Chang, Mee Soo; Jung, Yong Jin; So, Young; Lee, Myoung Seok; Bae, Jeong Mo; Kim, Byeong Gwan

doi:10.1111/liv.13549

Cited by 47 publications

(48 citation statements)

References 47 publications

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“…The study confirmed that negative predictive values (NPV) of FIB‐4, NFS and ARFI were all high, in contrast with relatively modest sensitivities and positive predictive values (PPV), therefore these tests appear best placed in clinical practice to indicate the absence of advanced fibrosis rather than to diagnose it. As already established, NFS and FIB‐4 were significantly better than APRI, AAR and BARD and interestingly they had similar negative predictive values to ARFI …”

supporting

confidence: 69%

“…In their study of 315 Asian patients with biopsy‐proven NAFLD, Joo and co‐authors compared the diagnostic accuracy of a variety of non‐invasive tests to detect advanced fibrosis, and evaluated the potential influence of steatosis and other metabolic comorbidities, such as obesity and the presence of metabolic syndrome. These tests included ARFI to obtain LSM, aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to Platelet ratio index (APRI), FIB‐4, NFS and BARD index (Body Mass Index, AST/ALT ratio, Diabetes) …”

mentioning

confidence: 99%

“…Dual cut‐off values were used for FIB‐4 and NFS to ‘rule in’ or ‘rule out’ patients with advanced fibrosis . Comparing the areas under receiver operating characteristic curve (AUROC), the authors identified FIB‐4 to have the best diagnostic accuracy for ruling out advanced fibrosis (NPV 94%, AUROC 0.87).…”

mentioning

confidence: 99%

“…Importantly, while the sensitivities, positive predictive values (PPV) and AUROC of these tests were lower in the context of severe steatosis, their NPV were relatively unchanged, permitting their use as screening tests for the exclusion of advanced fibrosis. On the other hand, caution is required to avoid overestimating positive results and LSM in patients with severe steatosis …”

mentioning

confidence: 99%

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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

Zakeri

Tsochatzis

2018

Liver International

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supporting

confidence: 69%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Zakeri

Tsochatzis

2018

Liver International

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“…To overcome these problems, non‐invasive diagnostic procedures have been proposed, for example, magnetic resonance and elastography—ultrasonography, which have even been compared to in vivo histochemical techniques . However, besides their complexity and costs, these procedures can be of poor diagnostic significance in some cases, as in obese patients . Another non‐invasive procedure supporting the assessment and follow‐up of liver disease progression is based on ultra‐high‐field magnetic resonance spectroscopy .…”

Section: Optical Biopsy In Hepatologymentioning

confidence: 99%

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Croce

Ferrigno

Bottiroli

et al. 2018

Liver International

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Autofluorescence emission of liver tissue depends on the presence of endogenous biomolecules able to fluoresce under suitable light excitation. Overall autofluorescence emission contains much information of diagnostic value because it is the sum of individual autofluorescence contributions from fluorophores involved in metabolism, for example, NAD(P)H, flavins, lipofuscins, retinoids, porphyrins, bilirubin and lipids, or in structural architecture, for example, fibrous proteins, in close relationship with normal, altered or diseased conditions of the liver. Since the 1950s, hepatocytes and liver have been historical models to study NAD(P)H and flavins as in situ, real-time autofluorescence biomarkers of energy metabolism and redox state. Later investigations designed to monitor organ responses to ischaemia/reperfusion were able to predict the risk of dysfunction in surgery and transplantation or support the development of procedures to ameliorate the liver outcome. Subsequently, fluorescent fatty acids, lipofuscin-like lipopigments and collagen were characterized as optical biomarkers of liver steatosis, oxidative stress damage, fibrosis and disease progression. Currently, serum AF is being investigated to improve non-invasive optical diagnosis of liver disease. Validation of endogenous fluorophores and in situ discrimination of cancerous from non-cancerous tissue belong to the few studies on liver in human subjects. These reports along with other optical techniques and the huge work performed on animal models suggest many optically based applications in hepatology. Optical diagnosis is currently offering beneficial outcomes in clinical fields ranging from the respiratory and gastrointestinal tracts, to dermatology and ophthalmology. Accordingly, this review aims to promote an effective bench to bedside transfer in hepatology.

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Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

et al. 2019

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Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver‐related morbidity. Noninvasive methods such as vibration‐controlled transient elastography (VCTE) and Fibrosis‐4 index (FIB‐4) have been recommended to identify patients for further assessment. The aim of this study was to assess the potential impact of implementing a “FIB‐4 First” strategy to triage patients entering a NAFLD assessment pathway. The pathway for patients with suspected NAFLD was piloted at a tertiary liver center. Referral criteria were 16‐65 years old, elevated alanine aminotransferase and/or steatosis on imaging, and absence of a previous liver diagnosis. A registered nurse risk‐stratified all patients based on VCTE and FIB‐4 was calculated. Potential alternative diagnoses were excluded with bloodwork. A total of 565 patients underwent risk stratification with VCTE with a 97% success rate. Ten percent had VCTE of at least 8 kPa; 560 patients had FIB‐4 available for analysis and 87% had values less than 1.3. Of those with a FIB‐4 of at least 1.3, 69% had a VCTE less than 8 kPa. Further modeling showed that the presence of diabetes, age, and body mass index had only a moderate impact on the association between FIB‐4 and elastography values if using a FIB‐4 threshold of 1.3. Conclusion: A FIB‐4 threshold of 1.3 was acceptable for excluding the presence of advanced fibrosis (assessed by VCTE). A staged risk‐stratification model using FIB‐4 and VCTE could save up to 87% of further assessments. This model could improve accessibility by moving the initial fibrosis evaluation to the medical home and helping to prioritize patients for further specialized care.

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Steatosis severity affects the diagnostic performances of noninvasive fibrosis tests in nonalcoholic fatty liver disease

Abstract: Steatosis severity may affect the diagnostic performances of noninvasive fibrosis tests in patients with NAFLD. The application of different tools should be tailored for various NAFLD subgroups to optimize noninvasive fibrosis assessments.

Cited by 47 publications

References 47 publications

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

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

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

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