Simple Noninvasive Scores Are Clinically Useful to Exclude, Not Predict, Advanced Fibrosis: A Study in Turkish Patients with Biopsy-Proven Nonalcoholic Fatty Liver Disease
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Background/Aims: Advanced fibrosis (F≥3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods: The diagnostic performance of each noninvasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored <1.3 and >2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored <–1.455 and >0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eighty-one patients (17.5%) had biopsy-proven advanced fibrosis (F≥3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (≥1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (≥–1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.
Abstract
Background/Aims: Advanced fibrosis (F≥3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods: The diagnostic performance of each noninvasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored <1.3 and >2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored <–1.455 and >0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eighty-one patients (17.5%) had biopsy-proven advanced fibrosis (F≥3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (≥1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (≥–1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.
참고문헌 (21)
- Younossi Z, "Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis", Hepatology, 69, pp.2672~2682 (2019)
- Angulo P, "Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease", Gastroenterology, 149, pp.389~397 (2015)
- Dulai PS, "Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease : systematic review and meta-analysis", Hepatology, 65, pp.1557~1565 (2017)
- Castera L, "Assessing liver fibrosis", Expert Rev Gastroenterol Hepatol, 2, pp.541~552 (2008)
- Adams LA, "Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease", Clin Liver Dis, 11, pp.25~35 (2007)
- Guha IN, "Noninvasive markers of fibrosis in nonalcoholic fatty liver disease : validating the European liver fibrosis panel and exploring simple markers", Hepatology, 47, pp.455~460 (2008)
- McPherson S, "Are simple noninvasive scoring systems for fibrosis reliable in patients with NAFLD and normal ALT levels", Eur J Gastroenterol Hepatol, 25, pp.652~658 (2013)
- Shah AG, "Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease", Clin Gastroenterol Hepatol, 7, pp.1104~1112 (2009)
- Angulo P, "The NAFLD fibrosis score : a noninvasive system that identifies liver fibrosis in patients with NAFLD", Hepatology, 45, pp.846~854 (2007)
- European Association for the Study of the Liver (EASL), "EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease", J Hepatol, 64, pp.1388~1402 (2016)
- Chalasani N, "The diagnosis and management of nonalcoholic fatty liver disease : practice guidance from the American Association for the Study of Liver Diseases", Hepatology, 67, pp.328~357 (2018)
- Buzzetti E, "Noninvasive assessment of fibrosis in patients with nonalcoholic fatty liver disease", Int J Endocrinol, 2015, pp.343828~ (2015)
- McPherson S, "Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis", Am J Gastroenterol, 112, pp.740~751 (2017)
- Yilmaz Y, "Serum biomarkers of fibrosis and extracellular matrix remodeling in patients with nonalcoholic fatty liver disease : association with liver histology", Eur J Gastroenterol Hepatol, 31, pp.43~46 (2019)
- Subasi CF, "Comparison of noninvasive scores for the detection of advanced fibrosis in patients with nonalcoholic fatty liver disease", Eur J Gastroenterol Hepatol, 27, pp.137~141 (2015)
- McPherson S, "Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease", Gut, 59, pp.1265~1269 (2010)
- Vetter TR, "Diagnostic testing and decisionmaking : beauty is not just in the eye of the beholder", Anesth Analg, 127, pp.1085~1091 (2018)
- Zhou JH, "Noninvasive evaluation of nonalcoholic fatty liver disease : current evidence and practice", World J Gastroenterol, 25, pp.1307~1326 (2019)
- Cheah MC, "Current modalities of fibrosis assessment in non-alcoholic fatty liver disease", J Clin Transl Hepatol, 5, pp.261~271 (2017)
- Friedrich-Rust M, "Performance of transient elastography for the staging of liver fibrosis : a metaanalysis", Gastroenterology, 134, pp.960~974 (2008)
- Wong VW, "Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease", Hepatology, 51, pp.454~462 (2010)