Jérôme Boursier1, Victor de Ledinghen2, Vincent Leroy3, Rodolphe Anty4, Sven Francque5, Dominique Salmon6, Adrien Lannes7, Sandrine Bertrais8, Frederic Oberti9, Isabelle Fouchard-Hubert9, Paul Calès9. 1. Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France. Electronic address: JeBoursier@chu-angers.fr. 2. Hepatology Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France; INSERM U1053, Bordeaux University, Bordeaux, France. 3. Hepato-Gastroenterology Clinic, University Hospital, Grenoble, France; INSERM U823, Grenoble Alpes University, Grenoble, France. 4. Digestive Center, University Hospital of Nice, Nice, France; INSERM U1065, Sophia-Antipolis Nice University, Nice, France. 5. Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium. 6. Internal Medicine Department, Cochin Hospital, APHP, Paris, France; Descartes University, Sorbonne Paris Cité, Paris, France. 7. Hepatology Department, University Hospital, Angers, France. 8. HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France. 9. Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
Abstract
BACKGROUND & AIMS: Chronic liver diseases (CLD) are common, and are therefore mainly managed by non-hepatologists. These physicians lack access to the best non-invasive tests of liver fibrosis, and consequently cannot accurately determine the disease severity. Referral to a hepatologist is then needed. We aimed to implement an algorithm, comprising a new first-line test usable by all physicians, for the detection of advanced liver fibrosis in all CLD patients. METHODS: Diagnostic study: 3754 CLD patients with liver biopsy were 2:1 randomized into derivation and validation sets. Prognostic study: longitudinal follow-up of 1275 CLD patients with baseline fibrosis tests. RESULTS: Diagnostic study: the easy liver fibrosis test (eLIFT), an "at-a-glance" sum of points attributed to age, gender, gamma-glutamyl transferase, aspartate aminotransferase (AST), platelets and prothrombin time, was developed for the diagnosis of advanced fibrosis. In the validation set, eLIFT and fibrosis-4 (FIB4) had the same sensitivity (78.0% vs. 76.6%, p=0.470) but eLIFT gave fewer false positive results, especially in patients ≥60years old (53.8% vs. 82.0%, p<0.001), and was thus more suitable as screening test. FibroMeter with vibration controlled transient elastography (VCTE) was the most accurate among the eight fibrosis tests evaluated. The sensitivity of the eLIFT-FMVCTE algorithm (first-line eLIFT, second-line FibroMeterVCTE) was 76.1% for advanced fibrosis and 92.1% for cirrhosis. Prognostic study: patients diagnosed as having "no/mild fibrosis" by the algorithm had excellent liver-related prognosis with thus no need for referral to a hepatologist. CONCLUSION: The eLIFT-FMVCTE algorithm extends the detection of advanced liver fibrosis to all CLD patients and reduces unnecessary referrals of patients without significant CLD to hepatologists. LAY SUMMARY: Blood fibrosis tests and transient elastography accurately diagnose advanced liver fibrosis in the large population of patients having chronic liver disease, but these non-invasive tests are only currently available in specialized centers. We have developed an algorithm including the easy liver fibrosis test (eLIFT), a new simple and widely available blood test. It is used as a first-line procedure that selects at-risk patients who need further evaluation with the FibroMeterVCTE, an accurate fibrosis test combining blood markers and transient elastography result. This new algorithm, called the eLIFT-FMVCTE, accurately identifies the patients with advanced chronic liver disease who need referral to a specialist, and those with no or mild liver lesions who can remain under the care of their usual physician. CLINICAL TRIAL REGISTRATION: No registration (analysis of pooled data from previously published diagnostic studies).
BACKGROUND & AIMS:Chronic liver diseases (CLD) are common, and are therefore mainly managed by non-hepatologists. These physicians lack access to the best non-invasive tests of liver fibrosis, and consequently cannot accurately determine the disease severity. Referral to a hepatologist is then needed. We aimed to implement an algorithm, comprising a new first-line test usable by all physicians, for the detection of advanced liver fibrosis in all CLD patients. METHODS: Diagnostic study: 3754 CLD patients with liver biopsy were 2:1 randomized into derivation and validation sets. Prognostic study: longitudinal follow-up of 1275 CLD patients with baseline fibrosis tests. RESULTS: Diagnostic study: the easy liver fibrosis test (eLIFT), an "at-a-glance" sum of points attributed to age, gender, gamma-glutamyl transferase, aspartate aminotransferase (AST), platelets and prothrombin time, was developed for the diagnosis of advanced fibrosis. In the validation set, eLIFT and fibrosis-4 (FIB4) had the same sensitivity (78.0% vs. 76.6%, p=0.470) but eLIFT gave fewer false positive results, especially in patients ≥60years old (53.8% vs. 82.0%, p<0.001), and was thus more suitable as screening test. FibroMeter with vibration controlled transient elastography (VCTE) was the most accurate among the eight fibrosis tests evaluated. The sensitivity of the eLIFT-FMVCTE algorithm (first-line eLIFT, second-line FibroMeterVCTE) was 76.1% for advanced fibrosis and 92.1% for cirrhosis. Prognostic study: patients diagnosed as having "no/mild fibrosis" by the algorithm had excellent liver-related prognosis with thus no need for referral to a hepatologist. CONCLUSION: The eLIFT-FMVCTE algorithm extends the detection of advanced liver fibrosis to all CLD patients and reduces unnecessary referrals of patients without significant CLD to hepatologists. LAY SUMMARY: Blood fibrosis tests and transient elastography accurately diagnose advanced liver fibrosis in the large population of patients having chronic liver disease, but these non-invasive tests are only currently available in specialized centers. We have developed an algorithm including the easy liver fibrosis test (eLIFT), a new simple and widely available blood test. It is used as a first-line procedure that selects at-risk patients who need further evaluation with the FibroMeterVCTE, an accurate fibrosis test combining blood markers and transient elastography result. This new algorithm, called the eLIFT-FMVCTE, accurately identifies the patients with advanced chronic liver disease who need referral to a specialist, and those with no or mild liver lesions who can remain under the care of their usual physician. CLINICAL TRIAL REGISTRATION: No registration (analysis of pooled data from previously published diagnostic studies).
Authors: Thierry Thévenot; Sophie Vendeville; Delphine Weil; Linda Akkouche; Paul Calame; Clémence M Canivet; Claire Vanlemmens; Carine Richou; Jean-Paul Cervoni; Marie-France Seronde; Vincent Di Martino; Jérôme Boursier Journal: PLoS One Date: 2022-05-26 Impact factor: 3.752
Authors: Katharina Staufer; Emina Halilbasic; Walter Spindelboeck; Magdalena Eilenberg; Gerhard Prager; Vanessa Stadlbauer; Andreas Posch; Petra Munda; Rodrig Marculescu; Barbara Obermayer-Pietsch; Judith Stift; Carolin Lackner; Michael Trauner; Rudolf E Stauber Journal: United European Gastroenterol J Date: 2019-07-12 Impact factor: 4.623
Authors: Yasaman Vali; Jenny Lee; Jérôme Boursier; René Spijker; Joanne Verheij; M Julia Brosnan; Quentin M Anstee; Patrick M Bossuyt; Mohammad Hadi Zafarmand Journal: J Clin Med Date: 2021-05-29 Impact factor: 4.241