Saleh A Alqahtani1,2,3, Pegah Golabi4,5, James M Paik4,5, Brian Lam4, Amir H Moazez5, Hazem A Elariny5, Zachary Goodman4, Zobair M Younossi6,7. 1. Center for Outcomes Research in Liver Diseases, Wasshington DC, 20037, USA. 2. Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, 21218, USA. 3. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. 4. Center For Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, 22042, USA. 5. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA. 6. Center For Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, 22042, USA. Zobair.Younossi@inova.org. 7. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA. Zobair.Younossi@inova.org.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patients, and fibrosis is an independent predictor of mortality. Noninvasive tests (NITs) are being developed for the detection of advanced fibrosis (AF). PURPOSE: To assess the performance of three NITs (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of AF among morbidly obese patients. MATERIALS AND METHODS: Patients, who underwent bariatric surgery between 2004 and 2009 and had liver biopsy, were included. Fibrosis stages ≥ F2 and ≥ F3 were defined as significant and AF, respectively. Published and optimal thresholds (Youden index) for NFS, FIB-4 and APRI, sensitivity, specificity, positive and negative predictive values (PPV-NPV), and area under the receiver operator curves (AUROC) were evaluated. RESULTS: Among 584 patients (mean age 43.3 ± 11.3 years, 21.2% male, 75% white, mean BMI 45.5 ± 8.80), 31.7% had NASH. Stages distributions were F1 = 68.1%, F2 = 16.4%, F3 = 8%, and F4 = 3.2%. At published thresholds, all 3 NITs performed poorly for detection of AF, with AUROC < 0.62. Overall performance at optimal thresholds improved to 0.68, 0.72, and 0.74 for NFS, FIB-4, and APRI, respectively. At optimal thresholds, all tests had good NPV (94.4-95.9%) but low PPV (24.2-32.5%). Combinations of the tests did not improve their performance. CONCLUSIONS: NFS, FIB-4, and APRI fall short to detect advanced fibrosis but valuable for excluding advanced fibrosis. More research is needed to develop new NITs with high positive predictive value.
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obesepatients, and fibrosis is an independent predictor of mortality. Noninvasive tests (NITs) are being developed for the detection of advanced fibrosis (AF). PURPOSE: To assess the performance of three NITs (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of AF among morbidly obesepatients. MATERIALS AND METHODS:Patients, who underwent bariatric surgery between 2004 and 2009 and had liver biopsy, were included. Fibrosis stages ≥ F2 and ≥ F3 were defined as significant and AF, respectively. Published and optimal thresholds (Youden index) for NFS, FIB-4 and APRI, sensitivity, specificity, positive and negative predictive values (PPV-NPV), and area under the receiver operator curves (AUROC) were evaluated. RESULTS: Among 584 patients (mean age 43.3 ± 11.3 years, 21.2% male, 75% white, mean BMI 45.5 ± 8.80), 31.7% had NASH. Stages distributions were F1 = 68.1%, F2 = 16.4%, F3 = 8%, and F4 = 3.2%. At published thresholds, all 3 NITs performed poorly for detection of AF, with AUROC < 0.62. Overall performance at optimal thresholds improved to 0.68, 0.72, and 0.74 for NFS, FIB-4, and APRI, respectively. At optimal thresholds, all tests had good NPV (94.4-95.9%) but low PPV (24.2-32.5%). Combinations of the tests did not improve their performance. CONCLUSIONS: NFS, FIB-4, and APRI fall short to detect advanced fibrosis but valuable for excluding advanced fibrosis. More research is needed to develop new NITs with high positive predictive value.
Authors: Naga Chalasani; Zobair Younossi; Joel E Lavine; Michael Charlton; Kenneth Cusi; Mary Rinella; Stephen A Harrison; Elizabeth M Brunt; Arun J Sanyal Journal: Hepatology Date: 2017-09-29 Impact factor: 17.425
Authors: Zobair M Younossi; Rohit Loomba; Quentin M Anstee; Mary E Rinella; Elisabetta Bugianesi; Giulio Marchesini; Brent A Neuschwander-Tetri; Lawrence Serfaty; Francesco Negro; Stephen H Caldwell; Vlad Ratziu; Kathleen E Corey; Scott L Friedman; Manal F Abdelmalek; Stephen A Harrison; Arun J Sanyal; Joel E Lavine; Philippe Mathurin; Michael R Charlton; Zachary D Goodman; Naga P Chalasani; Kris V Kowdley; Jacob George; Keith Lindor Journal: Hepatology Date: 2018-07 Impact factor: 17.425
Authors: Brandon J Perumpail; Muhammad Ali Khan; Eric R Yoo; George Cholankeril; Donghee Kim; Aijaz Ahmed Journal: World J Gastroenterol Date: 2017-12-21 Impact factor: 5.742