Isabel Graupera1, Maja Thiele2, Miquel Serra-Burriel3, Llorenç Caballeria4, Dominique Roulot5, Grace Lai-Hung Wong6, Núria Fabrellas7, Indra Neil Guha8, Anita Arslanow9, Carmen Expósito4, Rosario Hernández10, Guruprasad Padur Aithal8, Peter R Galle11, Guillem Pera4, Vincent Wai-Sun Wong6, Frank Lammert12, Pere Ginès1, Laurent Castera13, Aleksander Krag2. 1. Liver Unit Hospital Clínic. Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. 2. Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Department for Clinical Research, University of Southern Denmark, Odense, Denmark. 3. Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland. 4. USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain. 5. Department of Hepatology, AP-HP, Hopital Avicenne, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France. 6. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 7. Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain. 8. NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom. 9. Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany. 10. CAP La Marina, Institut Català de la Salut de Barcelona, Barcelona, Spain. 11. Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany. 12. Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany. 13. Hôpital Beaujon; Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France; Université Paris VII, Inserm Umr 1149, Centre de Recherche Sur L'inflammation, Paris, France.
Abstract
BACKGROUND & AIMS: Fibrosis-4 (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS) are the 2 most popular noninvasive blood-based serum tests proposed for widespread fibrosis screening. We therefore aimed to describe the accuracy of FIB-4 and NFS to detect elevated liver stiffness as an indicator of hepatic fibrosis in low-prevalence populations. METHODS: This study included a total of 5129 patients with concomitant measurement of FIB-4, NFS, and liver stiffness measurement (LSM) by Fibroscan (Echosens, France) from 5 independent population-based cohorts from Spain, Hong Kong, Denmark, England, and France; 3979 participants from the general population and 1150 from at-risk cohorts due to alcohol, diabetes, or obesity. We correlated LSM with FIB-4 and NFS, and calculated pre- and post-test predictive values of FIB-4 and NFS to detect elevated LSM at 8 kPa and 12 kPa cutoffs. The mean age was 53 ± 12 years, the mean body mass index was 27 ± 5 kg/m2, and 2439 (57%) were women. One in 10 patients (552; 11%) had liver stiffness ≥8 kPa, but 239 of those (43%) had a normal FIB-4, and 171 (31%) had normal NFS. The proportion of false-negatives was higher in at-risk patients than the general population. FIB-4 was false-negative in 11% of diabetic subjects, compared with 2.5% false-negatives with NFS. Waist circumference outperformed FIB-4 and NFS for detecting LSM ≥8 kPa in the general population. Almost one-third (28%-29%) of elevated FIB-4/NFS were false-positive in both the general population and at-risk cohorts. CONCLUSIONS: FIB-4 and NFS are suboptimal for screening purposes due to a high risk of overdiagnosis and a non-negligible percentage of false-negatives, especially in patients with risk factors for chronic liver disease. Waist circumference emerged as a potential first step to identify patients at risk for liver fibrosis in the general population.
BACKGROUND & AIMS: Fibrosis-4 (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS) are the 2 most popular noninvasive blood-based serum tests proposed for widespread fibrosis screening. We therefore aimed to describe the accuracy of FIB-4 and NFS to detect elevated liver stiffness as an indicator of hepatic fibrosis in low-prevalence populations. METHODS: This study included a total of 5129 patients with concomitant measurement of FIB-4, NFS, and liver stiffness measurement (LSM) by Fibroscan (Echosens, France) from 5 independent population-based cohorts from Spain, Hong Kong, Denmark, England, and France; 3979 participants from the general population and 1150 from at-risk cohorts due to alcohol, diabetes, or obesity. We correlated LSM with FIB-4 and NFS, and calculated pre- and post-test predictive values of FIB-4 and NFS to detect elevated LSM at 8 kPa and 12 kPa cutoffs. The mean age was 53 ± 12 years, the mean body mass index was 27 ± 5 kg/m2, and 2439 (57%) were women. One in 10 patients (552; 11%) had liver stiffness ≥8 kPa, but 239 of those (43%) had a normal FIB-4, and 171 (31%) had normal NFS. The proportion of false-negatives was higher in at-risk patients than the general population. FIB-4 was false-negative in 11% of diabetic subjects, compared with 2.5% false-negatives with NFS. Waist circumference outperformed FIB-4 and NFS for detecting LSM ≥8 kPa in the general population. Almost one-third (28%-29%) of elevated FIB-4/NFS were false-positive in both the general population and at-risk cohorts. CONCLUSIONS: FIB-4 and NFS are suboptimal for screening purposes due to a high risk of overdiagnosis and a non-negligible percentage of false-negatives, especially in patients with risk factors for chronic liver disease. Waist circumference emerged as a potential first step to identify patients at risk for liver fibrosis in the general population.
Authors: Alba Rojano-Toimil; Jesús Rivera-Esteban; Ramiro Manzano-Nuñez; Juan Bañares; David Martinez Selva; Pablo Gabriel-Medina; Roser Ferrer; Juan M Pericàs; Andreea Ciudin Journal: J Clin Med Date: 2022-06-08 Impact factor: 4.964
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