The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease

Abstract

Background & Aims The accuracy of noninvasive tools for the diagnosis of severe fibrosis in patients with nonalcoholic fatty liver disease(NAFLD) in clinical practice is still limited. We aimed at assessing the diagnostic performance of combined noninvasive tools in two independent cohorts of Italian NAFLD patients. Methods We analysed data from 321 Italian patients(179 Sicilian‐training cohort, and 142 northern Italy‐validation cohort) with an histological diagnosis of NAFLD. Severe fibrosis was defined as fibrosis ≥ F3 according to Kleiner classification. The APRI, AST/ALT, BARD, FIB‐4, and NFS scores were calculated according to published algorithms. Liver stiffness measurement(LSM) was performed by FibroScan. Cut‐off points of LSM, NFS and FIB‐4 for rule‐in or rule‐out F3‐F4 fibrosis were calculated by the reported formulas. Results In the Sicilian cohort AUCs of LSM, NFS, FIB‐4, LSM plus NFS, LSM plus FIB‐4, and NFS plus FIB‐4 were 0.857, 0.803, 0.790, 0.878, 0.888 and 0.807, respectively, while in the northern Italy cohort the corresponding AUCs were 0.848, 0.730, 0.703, 0.844, 0.850, and 0.733 respectively. In the training cohort, the combination of LSM plus NFS was the best performing strategy, providing false positive, false negative and uncertainty area rates of 0%,1.1% and 48% respectively. Similar results were obtained in the validation cohort with false positive, false negative and uncertainty area rates of 0%,7.3% and 40.8%. Conclusions The combination of LSM with NFS, two complementary, easy‐to‐perform, and widely available tools, is able to accurately diagnose or exclude the presence of severe liver fibrosis, also reducing of about 50–60% the number of needed diagnostic liver biopsies.

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

“…To what extent extra-hepatic metabolic risk phenotypes as well as underlying pathology contribute towards variation in liver stiffness measurement (LSM) and influences the efficacy of TE however remains incompletely understood [183][184][185][186][187] . Emerging evidence further suggests that the concurrent assessment of LSM and PNPLA3 genotype alongside existing composite prognostic models used to predict advanced hepatic fibrosis in NAFLD could improve their performance with the goal of decreasing the need for invasive liver biopsy [188,189] . Future studies should ideally aim to validate these preliminary findings in large-scale population-based prospective studies.…”

Застосування Принципу Мультипараметричного Ультразвуку Для Діагностики Неалкогольної Жирової хвороби Печінки В Пацієнтів Із цукровим діабетом 2-Го Типу

“…За даними літератури, інтенсивно вивчається вплив стеатозу на фіброз [12,13]. До стадій НАЖХП належить стеатоз і стеатогепатит (ранній стеатогепа-тит з фіброзом або без нього; фібротичний стеатоге-патит) [2].…”

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“…The third issue is that F3-F4 fibrosis is the most important prognostic factor for liver-related outcomes and mortality in NAFLD patients. TE performance is better for cirrhosis than for significant fibrosis [206,207]. TE has a higher rate of false-positive than false-negative results and a higher negative predictive value (NPV) than positive predictive value (PPV).…”