Fátima Higuera-de-la-Tijera1, Jacqueline Córdova-Gallardo2, Elizabeth Buganza-Torio3, Beatriz Barranco-Fragoso3, Aldo Torre4, Sara Parraguirre-Martínez5, Martin Edgardo Rojano-Rodríguez6, Gabriel Quintero-Bustos7, Graciela Castro-Narro4, Carlos Moctezuma-Velazquez8. 1. Department of Gastroenterology, Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Colonia Doctores, Alcaldía Cuauhtémoc, 06720, Mexico City, Mexico. 2. Hepatology Division, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico. 3. Departamento de Gastroenterología, Centro Médico Nacional 20 de Noviembre, Félix Cuevas 540, Colonia del Valle Sur, Alcaldía Benito Juárez, 03229, Mexico City, Mexico. 4. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico. 5. Pathology Division, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico. 6. Bariatric Surgery Division, Surgery Service, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico. 7. Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. 8. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico. mocmocte@hotmail.com.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been associated with different negative outcomes in the presence of advanced fibrosis. The Hepamet Fibrosis Score (HFS), a recently described noninvasive score, has shown excellent performance for the detection of advanced fibrosis. The aim of this study was to assess its performance in a Mexican population with NAFLD. METHODS: This was a retrospective cross-sectional study performed in 222 patients with biopsy-proven NAFLD, of whom 33(14%) had advanced fibrosis. We retrieved clinical data from each patient's medical record to compute the HFS, the NAFLD Fibrosis Score (NFS), and the Fibrosis-4 (FIB-4), and assess their performance. RESULTS: When considering the models as continuous variables, the area under the receiving operating characteristics curve of the HFS(0.758) was not different from that of the NFS(0.669, p = 0.09) or FIB-4(0.796, p = 0.1). The HFS had a sensitivity, specificity, positive and negative predictive values of 76.7% (95% CI 57.7-90.1), 90.1% (95% CI 85-93.9), 36.7% (95% CI 19.9-56.1), and 94.3% (95% CI 88.5-97.7), respectively. Indeterminate results (i.e., gray area) were more common with FIB-4 and HFS when compared with NFS [139(63%) and 122(55%) vs 80(36%), p < 0.001]. The variables that were associated with misclassification using the HFS were diabetes [OR 3.40 (95% CI 1.42-8.10), p = 0.006] and age [OR 1.06 (95% CI 1.01-1.11), p = 0.01]. CONCLUSION: The HFS showed sensitivity and specificity similar to that reported in the original publication; however, the positive predictive value was 36.7% at a pretest probability of 14%. The role of the HFS in prospective studies and in combination with other methods should be further explored.
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been associated with different negative outcomes in the presence of advanced fibrosis. The Hepamet Fibrosis Score (HFS), a recently described noninvasive score, has shown excellent performance for the detection of advanced fibrosis. The aim of this study was to assess its performance in a Mexican population with NAFLD. METHODS: This was a retrospective cross-sectional study performed in 222 patients with biopsy-proven NAFLD, of whom 33(14%) had advanced fibrosis. We retrieved clinical data from each patient's medical record to compute the HFS, the NAFLD Fibrosis Score (NFS), and the Fibrosis-4 (FIB-4), and assess their performance. RESULTS: When considering the models as continuous variables, the area under the receiving operating characteristics curve of the HFS(0.758) was not different from that of the NFS(0.669, p = 0.09) or FIB-4(0.796, p = 0.1). The HFS had a sensitivity, specificity, positive and negative predictive values of 76.7% (95% CI 57.7-90.1), 90.1% (95% CI 85-93.9), 36.7% (95% CI 19.9-56.1), and 94.3% (95% CI 88.5-97.7), respectively. Indeterminate results (i.e., gray area) were more common with FIB-4 and HFS when compared with NFS [139(63%) and 122(55%) vs 80(36%), p < 0.001]. The variables that were associated with misclassification using the HFS were diabetes [OR 3.40 (95% CI 1.42-8.10), p = 0.006] and age [OR 1.06 (95% CI 1.01-1.11), p = 0.01]. CONCLUSION: The HFS showed sensitivity and specificity similar to that reported in the original publication; however, the positive predictive value was 36.7% at a pretest probability of 14%. The role of the HFS in prospective studies and in combination with other methods should be further explored.
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