Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Abstract

This study aimed to examine whether the diagnostic accuracy of four noninvasive tests (NITs) for detecting advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is maintained or is inferior to with or without the presence of type 2 diabetes. Overall, 874 patients with biopsy‐proven NAFLD were enrolled. After propensity‐score matching by age, sex, and the prevalence of dyslipidemia, 311 patients were enrolled in each group of with or without diabetes. To evaluate the effect of diabetes, we compared the diagnostic accuracy of the fibrosis‐4 (FIB‐4) index, the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and type IV collagen 7S (COL4‐7S) in patients with NAFLD with and without diabetes. The areas under the receiver operating characteristic curve (AUROC) for identifying advanced fibrosis in patients without diabetes were 0.879 for the FIB‐4 index, 0.851 for the NFS, 0.862 for the APRI, and 0.883 for COL4‐7S. The AUROCs in patients with diabetes were 0.790 for the FIB‐4 index, 0.784 for the NFS, 0.771 for the APRI, and 0.872 for COL4‐7S. The AUROC of COL4‐7S was significantly larger than that of the other NITs in patients with NAFLD with diabetes than in those without diabetes. The optimal high and low cutoff points of COL4‐7S were 5.9 ng/mL and 4.8 ng/mL, respectively. At the low cutoff point, the accuracy of COL4‐7S was better than that of the other NITs, especially in patients with diabetes. Conclusion: COL4‐7S measurement might be the best NIT for identifying advanced fibrosis in NAFLD, especially in NAFLD with diabetes.

<strong>Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease</strong>

“…There is no problem regarding FIB-4 index as the 1st step premised on the use at the primary care physician or health checkup facility. However, among hepatologists, the low cutoff value should be 1.45 [27,28]), or 1.3 [29], or the low cutoff value should be 2.0 because Fib-4 index can overpredict in the elderly [30][31], the possibility that the FIB-4 index may show a false low value in diabetic patients [32] is not controversial, but it is sufficient to use it for the 1st step targeting 2 billion NAFLD patients [24]. On the other hand, VCTE (FibroScan) is not widely used in all institutions, and there are great expectations for serum markers.…”

MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis

“…This index owes its name to its two parameters, type IV collagen 7S and AST. Specifically, type IV collagen 7S is an indirect marker of fibrogenesis ( 94 ) and AST reiterates its role in liver dysfunction ( 36 ). Currently, the BFSS is used to predict NASH and fibrosis, with AUROC of 0.85 and 0.91, respectively ( 95 ).…”

“…Currently, the BFSS is used to predict NASH and fibrosis, with AUROC of 0.85 and 0.91, respectively ( 95 ). Moreover, it identifies MAFLD/NAFLD without fibrosis and NASH-related fibrosis ( 94 , 96 ). Unfortunately, the CA index was only validated in the Japanese population, similarly to the NAFIC score ( 97 ).…”

Editorial: Noninvasive Fibrosis Biomarkers in Patients With NASH With Diabetes

“…In this paper, Ishiba et al ( 7 ) describe type IV collagen 7S (COL4‐7S) as a serum marker of fibrosis in patients with NAFLD and T2DM. In the 311 patients enrolled with biopsy‐proven NAFLD, COL4‐7S measurements resulted in a significantly higher area under the curve (AUROC), compared with the FIB‐4 score, NAFLD fibrosis score, and APRI.…”