A sequential approach using the age‐adjusted fibrosis‐4 index and vibration‐controlled transient elastography to detect advanced fibrosis in Korean patients with non‐alcoholic fatty liver disease. Issue 8 (9th January 2022)

• Record Type: Journal Article
• Authors: Lee, Dong Hyeon; Sung, Se Un; Lee, Yun Kyu; Lim, Ik Hyeon; Jang, Heejoon; Joo, Sae Kyoung; Park, Jeong Hwan; Chang, Mee Soo; So, Young Ho; Kim, Won
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 55:Issue 8(2022)
• Page Start: 994
• Page End: 1007
• Publication Date: 2022-01-09
• 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.16766
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background and Aims: Vibration‐controlled transient elastography (VCTE) has shown good diagnostic performance in predicting fibrosis stages in patients with non‐alcoholic fatty liver disease (NAFLD). However, an optimal diagnostic approach to detect advanced fibrosis in patients with NAFLD has not been established. Approach and Results: We prospectively collected data from 539 subjects who underwent liver biopsy at a single centre between January 2014 and December 2019. Diagnostic performance was estimated using the area under the receiver‐operating characteristic curve (AUROC). Several models combining the fibrosis 4 index (FIB‐4) score and liver stiffness measurement (LSM) were analysed to reduce the need for unnecessary liver biopsies. We observed significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) in 173 (32.1%), 74 (13.7%) and 46 subjects (8.5%), respectively. The AUROCs (95% CI) for LSMs to diagnose ≥F2, ≥F3 and F4 were 0.82 (0.78‐0.85), 0.92 (0.89‐0.94) and 0.95 (0.93‐0.97), respectively. Optimal LSM cut‐off values were 6.7 (≥F2), 8.3 (≥F3) and 9.8 (F4) kPa. LSMs were affected by waist circumference, serum albumin and fibrosis stage (R 2 = 0.315). Abdominal obesity, elevated transaminase, diabetes mellitus and high IQR/Median were associated with the discordance of ≥2 fibrosis stages between LSMs and histologic data. The sequential use of the age‐adjusted FIB‐4 and LSMs yielded the least uncertainty (5.3%) in classifying disease severity with the highest diagnostic accuracy (81%) among a variety of non‐invasive test combinations. Conclusions: The sequential approach of age‐adjusted FIB‐4 and VCTE could represent a practical diagnostic strategy to detect advanced fibrosis in NAFLD (ClinicalTrials.gov #NCT 02206841). Abstract : A sequential approach using the age‐adjusted FIB‐4 and VCTE to detect advanced fibrosis in Korean patients with NAFLD.