Stepwise Combination of Simple Noninvasive Fibrosis Scoring Systems Increases Diagnostic Accuracy in Nonalcoholic Fatty Liver Disease

Demir, Münevver; Lang, Sonja; Nierhoff, Dirk; Drebber, Uta; Hardt, Aline; Wedemeyer, Inga; Schulte, Sigrid; Quasdorff, Maria; Goeser, Tobias; Töx, Ulrich; Steffen, Hans‐Michael

doi:10.1097/mcg.0b013e3182819a89

Cited by 40 publications

(33 citation statements)

References 34 publications

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“…Although all the pathologists reading the biopsies are highly experienced hepatopathologists, there is potential for interobserver variability, which may have led to a lowering of the diagnostic accuracy of the tests. Despite these limitations, the overall diagnostic accuracy of the non-invasive scores assessed in the present study are in keeping with other studies and this is the first study to specifically assess these scores in specific age groups (17, 18, 20, 30, 31, 32). …”

Section: Discussionsupporting

confidence: 84%

“…Previous studies have shown that these scores can reliably exclude advanced fibrosis in patients with NAFLD, and as a result, they provide a useful, inexpensive first-line assessment of liver fibrosis for use in primary or secondary care (16, 18, 19). Although fidelity appears lower when applied in bariatric surgery cohorts (29), several studies have now validated their use in large populations of patients with biopsy-proven NAFLD (17, 20, 30, 31, 32). However, the majority of patients included in these studies were in middle age (typical mean age of 45–55 years), with very few younger (≤35 years) or older patients (≥65 years) included.…”

Section: Discussionmentioning

confidence: 99%

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Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

McPherson

Hardy

Dufour

et al. 2017

American Journal of Gastroenterology

605

567

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OBJECTIVES:Non-invasive fibrosis scores are widely used to identify/exclude advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). However, these scores were principally developed and validated in patients aged between 35 and 65 years of age. The objective of this study was to assess the effect of age on the performance of non-invasive fibrosis tests in NAFLD.METHODS:Patients were recruited from European specialist hepatology clinics. The cohort was divided into five age-based groups: ≤35 (n=74), 36–45 (n=96), 46–55 (n=197), 56–64 (n=191), and ≥65 years (n=76), and the performance of the aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, fibrosis 4 (FIB-4), and NAFLD fibrosis score (NFS) for advanced fibrosis (stage F3–F4) for each group was assessed using liver biopsy as the standard.RESULTS:Six hundred and thirty-four patients were included. The diagnostic accuracy of the AST/ALT ratio was lower than NFS and FIB-4 in all the age groups. The AST/ALT ratio, NFS, and FIB-4 score performed poorly for a diagnosis of advanced fibrosis in those aged ≤35 years (area under the receiver operating characteristic curves (AUROCs 0.52, 0.52, and 0.60, respectively). For all groups >35 years, AUROCs for advanced fibrosis were similar for the NFS and FIB-4 score (range 0.77–0.84). However, the specificity for advanced fibrosis using the FIB-4 and NFS declined with age, becoming unacceptably low in those aged ≥65 years (35% for FIB-4 and 20% for NFS). New cutoffs were derived (and validated) for those aged ≥65 years, which improved specificity to 70% without adversely affecting sensitivity (FIB-4 2.0, sensitivity 77% NFS 0.12, sensitivity 80%).CONCLUSIONS:The NFS and FIB-4 scores have similar accuracy for advanced fibrosis in patients aged >35 years. However, the specificity for advanced fibrosis is unacceptably low in patients aged ≥65 years, resulting in a high false positive rate. New thresholds for use in patients aged ≥65 years are proposed to address this issue.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

McPherson

Hardy

Dufour

et al. 2017

American Journal of Gastroenterology

605

567

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“…Other non‐invasive systems such as AAR and the APRI test were not considered because they were not analyzed in Demir et al. 's study, which was selected in our study. Second, these non‐invasive scoring systems may not indicate changes in liver fibrosis stages because parameters used in these non‐invasive systems were not the crucial biomarkers that reflect the liver fibrosis process.…”

Section: Discussionmentioning

confidence: 99%

Comparison of FIB‐4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non‐alcoholic fatty liver disease: A meta‐analysis study

Sun

Cui

et al. 2016

Hepatology Research

188

119

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“…Its utility seems highest in predicting severe fibrosis, or even cirrhosis, and portal hypertension 51 . Demir et-al 52 found that using the FIB-4 sequentially with the BARD decreased the incidence of misdiagnosis of fibrosis stage. Thus, the role of BARD may be to rule out severe fibrosis, or in conjunction with another noninvasive fibrosis model to predict less severe fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Markers of Fibrosis and Inflammation in Nonalcoholic Fatty Liver Disease

Jayakumar

Harrison²,

Loomba

2016

Curr Hepatology Rep

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The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide. Nonalcoholic steatohepatitis (NASH) and fibrosis are associated with elevated morbidity and mortality, and a means of differentiating these diseases from simple steatosis (SS) is needed. Liver biopsy in all patients with NAFLD is not feasible, thus necessitating a noninvasive method for discerning the presence of inflammation and fibrosis. Of the various serum markers, cytokeratin-18 seems to best predict NASH, the NAFLD Fibrosis Score is most closely correlated with fibrosis, and transient elastography can be used for diagnosis of cirrhosis, or to exclude cirrhosis, although its utility is limited by obesity.

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Stepwise Combination of Simple Noninvasive Fibrosis Scoring Systems Increases Diagnostic Accuracy in Nonalcoholic Fatty Liver Disease

Cited by 40 publications

References 34 publications

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

Comparison of FIB‐4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non‐alcoholic fatty liver disease: A meta‐analysis study

Noninvasive Markers of Fibrosis and Inflammation in Nonalcoholic Fatty Liver Disease

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