Wah-Kheong Chan1, Sombat Treeprasertsuk2, George Boon-Bee Goh3, Jian-Gao Fan4, Myeong Jun Song5, Phunchai Charatcharoenwitthaya6, Ajay Duseja7, Yock-Young Dan8, Kento Imajo9, Atsushi Nakajima9, Khek-Yu Ho8, Khean-Lee Goh10, Vincent Wai-Sun Wong11. 1. Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: wahkheong2003@hotmail.com. 2. Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand. 3. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore. 4. Department of Gastroenterology, Shanghai Jiaotong University School of Medicine, Shanghai, China. 5. Division of Hepatology and Gastroenterology, Department of Internal Medicine, The Catholic University Korea, Korea. 6. Division of Gastroenterology, Department of Medicine, Mahidol University, Bangkok, Thailand. 7. Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 8. Division of Gastroenterology and Hepatology, Department of Medicine, National University of Singapore, Singapore. 9. Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 10. Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 11. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Abstract
BACKGROUND & AIMS: Measuring liver stiffness only in patients with indeterminate or high nonalcoholic fatty liver disease (NAFLD) fibrosis scores (called a 2-step approach) was reported to reduce indeterminate or discordant results while maintaining the accuracy to identify patients with advanced fibrosis. We aimed to validate this approach using data collected from the Gut and Obesity in Asia Workgroup. METHODS: We performed a retrospective analysis of data from 759 patients with biopsy-proven NAFLD (24% with advanced fibrosis), seen at 10 centers in 9 countries in Asia, from 2006 through 2018. By using liver biopsies as the reference standard, we calculated percentages of misclassifications and indeterminate or discordant results from assessments made based on fibrosis scores (NAFLD fibrosis score [NFS] or Fibrosis-4 score) and liver stiffness measurements (LSMs), alone or in combination. The analysis was repeated using randomly selected subgroups with a different prevalence of advanced fibrosis (histologic fibrosis stage ≥F3). RESULTS: In groups in which 3.7% and 10% of patients had advanced fibrosis, a 2-step approach (using the NFS followed by LSM only for patients with indeterminate or high NFS) and using a gray zone of 10 to 15 kPa for LSM, produced indeterminate or discordant results for 6.9% of patients and misclassified 2.7% of patients; only 25.6% of patients required LSM. In the group in which 10% of patients had advanced fibrosis, the same approach produced indeterminate or discordant results for 7.9% of patients and misclassified 6.6% of patients; only 27.4% of patients required LSM. In groups in which 24% and 50% of patients had advanced fibrosis, using LSM ≥10 kPa alone for the diagnosis of advanced fibrosis had the highest accuracy and misclassified 18.1% and 18.3% of patients, respectively. These results were similar when the Fibrosis-4 score was used in place of NFS. CONCLUSIONS: In a retrospective analysis, we found that a 2-step approach using fibrosis scores followed by LSM most accurately detects advanced fibrosis in populations with a low prevalence of advanced fibrosis. However, LSM ≥10 kPa identifies patients with advanced fibrosis with the highest level of accuracy in populations with a high prevalence of advanced fibrosis.
BACKGROUND & AIMS: Measuring liver stiffness only in patients with indeterminate or high nonalcoholic fatty liver disease (NAFLD) fibrosis scores (called a 2-step approach) was reported to reduce indeterminate or discordant results while maintaining the accuracy to identify patients with advanced fibrosis. We aimed to validate this approach using data collected from the Gut and Obesity in Asia Workgroup. METHODS: We performed a retrospective analysis of data from 759 patients with biopsy-proven NAFLD (24% with advanced fibrosis), seen at 10 centers in 9 countries in Asia, from 2006 through 2018. By using liver biopsies as the reference standard, we calculated percentages of misclassifications and indeterminate or discordant results from assessments made based on fibrosis scores (NAFLD fibrosis score [NFS] or Fibrosis-4 score) and liver stiffness measurements (LSMs), alone or in combination. The analysis was repeated using randomly selected subgroups with a different prevalence of advanced fibrosis (histologic fibrosis stage ≥F3). RESULTS: In groups in which 3.7% and 10% of patients had advanced fibrosis, a 2-step approach (using the NFS followed by LSM only for patients with indeterminate or high NFS) and using a gray zone of 10 to 15 kPa for LSM, produced indeterminate or discordant results for 6.9% of patients and misclassified 2.7% of patients; only 25.6% of patients required LSM. In the group in which 10% of patients had advanced fibrosis, the same approach produced indeterminate or discordant results for 7.9% of patients and misclassified 6.6% of patients; only 27.4% of patients required LSM. In groups in which 24% and 50% of patients had advanced fibrosis, using LSM ≥10 kPa alone for the diagnosis of advanced fibrosis had the highest accuracy and misclassified 18.1% and 18.3% of patients, respectively. These results were similar when the Fibrosis-4 score was used in place of NFS. CONCLUSIONS: In a retrospective analysis, we found that a 2-step approach using fibrosis scores followed by LSM most accurately detects advanced fibrosis in populations with a low prevalence of advanced fibrosis. However, LSM ≥10 kPa identifies patients with advanced fibrosis with the highest level of accuracy in populations with a high prevalence of advanced fibrosis.
Authors: Fasiha Kanwal; Jay H Shubrook; Leon A Adams; Kim Pfotenhauer; Vincent Wai-Sun Wong; Eugene Wright; Manal F Abdelmalek; Stephen A Harrison; Rohit Loomba; Christos S Mantzoros; Elisabetta Bugianesi; Robert H Eckel; Lee M Kaplan; Hashem B El-Serag; Kenneth Cusi Journal: Gastroenterology Date: 2021-09-20 Impact factor: 33.883