Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease. Issue 10 (29th September 2014)

• Record Type: Journal Article
• Authors: Fedchuk, L.; Nascimbeni, F.; Pais, R.; Charlotte, F.; Housset, C.; Ratziu, V.; the LIDO Study Group
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 10(2014)
• Page Start: 1209
• Page End: 1222
• Publication Date: 2014-09-29
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12963
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12963-abs-0001"> <title>Summary</title> <sec id="apt12963-sec-0001" sec-type="section"> <title>Background</title> <p>Several steatosis biomarkers are available with limited independent validation.</p> </sec> <sec id="apt12963-sec-0002" sec-type="section"> <title>Aim</title> <p>To determine diagnostic value and limitations of several steatosis biomarkers using liver biopsy as reference standard in a large cohort of patients with suspected NAFLD.</p> </sec> <sec id="apt12963-sec-0003" sec-type="section"> <title>Methods</title> <p>Three hundred and twenty‐four consecutive liver biopsies were included. Histological steatosis was categorised as none (<5%), mild (5–33%), moderate (33–66%) and severe (>66%). Five steatosis biomarkers were measured: fatty liver index (FLI), NAFLD liver fat score (NAFLD‐LFS), hepatic steatosis index (HSI), visceral adiposity index (VAI) and triglyceride × glucose (TyG) index.</p> </sec> <sec id="apt12963-sec-0004" sec-type="section"> <title>Results</title> <p>Steatosis grades prevalence was: none 5%, mild 39%, moderate 30% and severe 27%. Except for VAI, the steatosis biomarkers showed a linear trend across the steatosis grades. However, their correlation with the histological amount of steatosis was only weak‐moderate. All steatosis biomarkers had an adequate diagnostic accuracy for the presence of steatosis: AUROCs for FLI, LFS, HSI, VAI and TyG were 0.83, 0.80, 0.81, 0.92 and 0.90. However, their ability to quantify steatosis was poor: none of them distinguished between moderate and severe steatosis and the AUROCs for predicting steatosis >33% were 0.65, 0.72, 0.65, 0.59 and 0.59 for FLI, LFS, HSI, VAI and TyG. Both fibrosis and inflammation significantly confounded the association between steatosis biomarkers and steatosis. The steatosis biomarkers were all correlated with HOMA‐IR, independent from histological steatosis.</p> </sec> <sec id="apt12963-sec-0005" sec-type="section"> <title>Conclusions</title> <p>All five steatosis biomarkers can diagnose steatosis and are correlated with insulin resistance. They are confounded by fibrosis and inflammation, and do not accurately quantify steatosis; this may limit their clinical utility. More research is needed to identify truly independent and quantitative markers of steatosis.</p> </sec> </abstract>