Abdulrahman Ismaiel1, Daniel-Corneliu Leucuta2, Stefan-Lucian Popa1, Sharmila Fagoonee3, Rinaldo Pellicano4, Ludovico Abenavoli5, Dan L Dumitrascu1. 1. Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. 2. Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania - dleucuta@umfcluj.ro. 3. Institute for Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy. 4. Unit of Gastroenterology, Molinette Hospital, Turin, Italy. 5. Department of Health Sciences, Magna Graecia University, Catanzaro, Italy.
Abstract
INTRODUCTION: Nonalcoholic steatohepatitis (NASH) is characterized by hepatic steatosis with inflammation, ballooned hepatocytes and possible fibrosis, which may progress to liver cirrhosis. Although liver biopsy, remains the diagnostic gold standard of NASH, several noninvasive biomarkers have been studied, to avoid the need for this invasive procedure. We performed a systematic review with meta-analysis to evaluate the accuracy of several noninvasive biomarkers in predicting NASH and assessing liver fibrosis in NASH patients. EVIDENCE ACQUISITION: An electronic search on PubMed and Embase was systematically performed. The principal summary outcome was the area under the curve (AUC), assessing the accuracy of NashTest, BARD (Body Mass Index, AST/ALT ratio, diabetes) score, NAFLD fibrosis score (NFS), APRI (aspartate aminotransferase-to-Platelet Ratio Index), and Fibrosis-4 (FIB-4) Index in predicting NASH and assessing liver fibrosis. EVIDENCE SYNTHESIS: Thirteen studies involving 6557 adult patients were included in the qualitative assessment of this review, out of which, six studies were included in the quantitative assessment. Prediction of NASH was evaluated better using NFS (AUC of 0.687) and FIB-4 (AUC of 0.729). Fibrosis stages 0 vs. 1-4 was diagnosed better using NFS (AUC of 0.718) and FIB-4 (AUC of 0.723). Advanced fibrosis was assessed better by BARD (AUC of 0.673), APRI (AUC of 0.762), NFS (AUC of 0.787) and FIB-4 (AUC of 0.821). CONCLUSIONS: FIB-4 predicted NASH and quantified liver fibrosis, stages 0 vs. 1-4 more precisely compared to NFS, APRI, and BARD. However, considering that methodological quality of the assessed studies is limited, the results should be considered with caution.
INTRODUCTION: Nonalcoholic steatohepatitis (NASH) is characterized by hepatic steatosis with inflammation, ballooned hepatocytes and possible fibrosis, which may progress to liver cirrhosis. Although liver biopsy, remains the diagnostic gold standard of NASH, several noninvasive biomarkers have been studied, to avoid the need for this invasive procedure. We performed a systematic review with meta-analysis to evaluate the accuracy of several noninvasive biomarkers in predicting NASH and assessing liver fibrosis in NASH patients. EVIDENCE ACQUISITION: An electronic search on PubMed and Embase was systematically performed. The principal summary outcome was the area under the curve (AUC), assessing the accuracy of NashTest, BARD (Body Mass Index, AST/ALT ratio, diabetes) score, NAFLD fibrosis score (NFS), APRI (aspartate aminotransferase-to-Platelet Ratio Index), and Fibrosis-4 (FIB-4) Index in predicting NASH and assessing liver fibrosis. EVIDENCE SYNTHESIS: Thirteen studies involving 6557 adult patients were included in the qualitative assessment of this review, out of which, six studies were included in the quantitative assessment. Prediction of NASH was evaluated better using NFS (AUC of 0.687) and FIB-4 (AUC of 0.729). Fibrosis stages 0 vs. 1-4 was diagnosed better using NFS (AUC of 0.718) and FIB-4 (AUC of 0.723). Advanced fibrosis was assessed better by BARD (AUC of 0.673), APRI (AUC of 0.762), NFS (AUC of 0.787) and FIB-4 (AUC of 0.821). CONCLUSIONS: FIB-4 predicted NASH and quantified liver fibrosis, stages 0 vs. 1-4 more precisely compared to NFS, APRI, and BARD. However, considering that methodological quality of the assessed studies is limited, the results should be considered with caution.
Authors: Yusuf Yilmaz; Nimet Yilmaz; Fehmi Ates; Fatih Karakaya; Hale Gokcan; Eda Kaya; Gupse Adali; Aysun Caliskan Kartal; Ilker Sen; Emel Ahishali; Seren Ozenirler; Mehmet Koruk; Ahmet Uygun; Ramazan Idilman Journal: Hepatol Forum Date: 2021-05-21
Authors: E Scarpellini; L Abenavoli; V Cassano; E Rinninella; M Sorge; F Capretti; C Rasetti; G Svegliati Baroni; F Luzza; P Santori; A Sciacqua Journal: Front Med (Lausanne) Date: 2022-04-26