Prediction of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: An Enhanced Model of BARD Score
2
조회
0
다운로드
4
인용
0
참고문헌
초록
Background/Aims: The BARD score is a model to detect advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients. The aims of this study were to identify additional factors and then to build an enhanced version of the BARD score. Methods: One hundred seven patients with biopsy-proven NAFLD were enrolled retrospectively. Logistic regressions were performed to identify independent risk factors for advanced liver fibrosis (stage 3 or 4). An enhanced model of the BARD score (BARDI score) was built and evaluated with a receiver operating characteristic (ROC) curve. Results: In multivariate analysis, age (odds ratio [OR], 0.89;p=0.04), aspartate aminotransferase/alanine aminotransferase ratio (OR, 1.73; p<0.01), and international normalized ratio (INR) (OR, 8.85; p<0.01) were independently significant factors. The BARDI score was created by adding the INR to the BARD. The area under the ROC curve of the BARDI score was significantly larger than that of the BARD score (0.881 vs 0.808, p<0.01). A BARDI score of 3 or more showed a positive predictive value (PPV) of 51.0% and a negative predictive value (NPV) of 96.0%. Conclusions: The BARDI score had an improved PPV over the BARD score and maintained an excellent NPV. Further study is warranted for its external validation and comparison with other models.
Abstract
Background/Aims: The BARD score is a model to detect advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients. The aims of this study were to identify additional factors and then to build an enhanced version of the BARD score. Methods: One hundred seven patients with biopsy-proven NAFLD were enrolled retrospectively. Logistic regressions were performed to identify independent risk factors for advanced liver fibrosis (stage 3 or 4). An enhanced model of the BARD score (BARDI score) was built and evaluated with a receiver operating characteristic (ROC) curve. Results: In multivariate analysis, age (odds ratio [OR], 0.89;p=0.04), aspartate aminotransferase/alanine aminotransferase ratio (OR, 1.73; p<0.01), and international normalized ratio (INR) (OR, 8.85; p<0.01) were independently significant factors. The BARDI score was created by adding the INR to the BARD. The area under the ROC curve of the BARDI score was significantly larger than that of the BARD score (0.881 vs 0.808, p<0.01). A BARDI score of 3 or more showed a positive predictive value (PPV) of 51.0% and a negative predictive value (NPV) of 96.0%. Conclusions: The BARDI score had an improved PPV over the BARD score and maintained an excellent NPV. Further study is warranted for its external validation and comparison with other models.
참고문헌 (19)
- Browning JD, "Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity", Hepatology, 40, pp.1387~1395 (2004)
- Lewis JR, "Nonalcoholic fatty liver disease: a review and update", Dig Dis Sci, 55, pp.560~578 (2010)
- Alba LM, "Review article: non-alcoholic fatty liver disease", Aliment Pharmacol Ther, 17, pp.977~986 (2003)
- Seeff LB, "Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial", Clin Gastroenterol Hepatol, 8, pp.877~883 (2010)
- Wong VW, "Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease", Hepatology, 51, pp.454~462 (2010)
- Yoneda M, "Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD)", Gut, 56, pp.1330~1331 (2007)
- Yoneda M, "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD)", Dig Liver Dis, 40, pp.371~378 (2008)
- Szczepaniak LS, "Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population", Am J Physiol Endocrinol Metab, 288, pp.E462~E468 (2005)
- Talwalkar JA, "Magnetic resonance imaging of hepatic fibrosis: emerging clinical applications", Hepatology, 47, pp.332~342 (2008)
- Tsuda N, "Potential of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) for differential diagnosis of nonalcoholic steatohepatitis and fatty liver in rats using magnetic resonance imaging", Invest Radiol, 42, pp.242~247 (2007)
- Ratziu V, "Liver fibrosis in overweight patients", Gastroenterology, 118, pp.1117~1123 (2000)
- Rosenberg WM, "Serum markers detect the presence of liver fibrosis: a cohort study", Gastroenterology, 127, pp.1704~1713 (2004)
- Sterling RK, "Development of a simple noninvasive index to predict significant fibrosis in patients with HIV", HCV coinfection, 2006, pp.43, 1317~1325
- 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)
- Harrison SA, "Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease", Gut, 57, pp.1441~1447 (2008)
- Angulo P, "The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD", Hepatology, 45, pp.846~854 (2007)
- Brunt EM, "Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions", Am J Gastroenterol, 94, pp.2467~2474 (1999)
- "SAS macro CVLR (cross-validation for logistic regression)" (2000)[URL]
- Centers for Disease Control and Prevention (CDC), "Estimated county-level prevalence of diabetes and obesity: United States", MMWR Morb Mortal Wkly Rep, 58, pp.1259~1263 (2009), MMWR Morb Mortal Wkly Rep