Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Issue 5 (17th May 2021)

• Record Type: Journal Article
• Authors: Mózes, Ferenc Emil; Lee, Jenny A; Selvaraj, Emmanuel Anandraj; Jayaswal, Arjun Narayan Ajmer; Trauner, Michael; Boursier, Jerome; Fournier, Céline; Staufer, Katharina; Stauber, Rudolf E; Bugianesi, Elisabetta; Younes, Ramy; Gaia, Silvia; Lupșor-Platon, Monica; Petta, Salvatore; Shima, Toshihide; Okanoue, Takeshi; Mahadeva, Sanjiv; Chan, Wah-Kheong; Eddowes, Peter J; Hirschfield, Gideon M; Newsome, Philip Noel; Wong, Vincent Wai-Sun; de Ledinghen, Victor; Fan, Jiangao; Shen, Feng; Cobbold, Jeremy F; Sumida, Yoshio; Okajima, Akira; Schattenberg, Jörn M; Labenz, Christian; Kim, Won; Lee, Myoung Seok; Wiegand, Johannes; Karlas, Thomas; Yılmaz, Yusuf; Aithal, Guruprasad Padur; Palaniyappan, Naaventhan; Cassinotto, Christophe; Aggarwal, Sandeep; Garg, Harshit; Ooi, Geraldine J; Nakajima, Atsushi; Yoneda, Masato; Ziol, Marianne; Barget, Nathalie; Geier, Andreas; Tuthill, Theresa; Brosnan, M. Julia; Anstee, Quentin Mark; Neubauer, Stefan; Harrison, Stephen A.; Bossuyt, Patrick M; Pavlides, Michael;
• Other Names: author non-byline.; Anstee Quentin author non-byline.; Daly Ann author non-byline.; Johnson Katherine author non-byline.; Govaere Olivier author non-byline.; Cockell Simon author non-byline.; Tiniakos Dina author non-byline.; Bedossa Pierre author non-byline.; Oakley Fiona author non-byline.; Cordell Heather author non-byline.; Day Chris author non-byline.; Wonders Kristy author non-byline.; Bossuyt Patrick author non-byline.; Zafarmand Hadi author non-byline.; Vali Yasaman author non-byline.; Lee Jenny author non-byline.; Ratziu Vlad author non-byline.; Clement Karine author non-byline.; Pais Raluca author non-byline.; Schuppan Detlef author non-byline.; Schattenberg Jörn author non-byline.; Schuppan Detlef author non-byline.; Schattenberg Jörn author non-byline.; Vidal-Puig Toni author non-byline.; Vacca Michele author non-byline.; Rodrigues-Cuenca Sergio author non-byline.; Allison Mike author non-byline.; Kamzolas Ioannis author non-byline.; Petsalaki Evangelia author non-byline.; Oresic Matej author non-byline.; Hyötyläinen Tuulia author non-byline.; McGlinchey Aiden author non-byline.; Mato Jose M author non-byline.; Millet Oscar author non-byline.; Dufour Jean-François author non-byline.; Berzigotti Annalisa author non-byline.; Pavlides Michael author non-byline.; Harrison Stephen author non-byline.; Neubauer Stefan author non-byline.; Cobbold Jeremy author non-byline.; Mozes Ferenc author non-byline.; Akhtar Salma author non-byline.; Banerjee Rajarshi author non-byline.; Kelly Matt author non-byline.; Shumbayawonda Elizabeth author non-byline.; Dennis Andrea author non-byline.; Erpicum Charlotte author non-byline.; Graham Micheala author non-byline.; Romero-Gómez Manuel author non-byline.; Gómez-González Emilio author non-byline.; Ampuero Javier author non-byline.; Castell Javier author non-byline.; Gallego-Durán Rocío author non-byline.; Fernández Isabel author non-byline.; Montero-Vallejo Rocío author non-byline.; Karsdal Morten author non-byline.; Erhardtsen Elisabeth author non-byline.; Rasmussen Daniel author non-byline.; Leeming Diana Julie author non-byline.; Fisker Mette Juul author non-byline.; Sinisi Antonia author non-byline.; Musa Kishwar author non-byline.; Betsou Fay author non-byline.; Sandt Estelle author non-byline.; Tonini Manuela author non-byline.; Bugianesi Elisabetta author non-byline.; Rosso Chiara author non-byline.; Armandi Angelo author non-byline.; Marra Fabio author non-byline.; Gastaldelli Amalia author non-byline.; Svegliati Gianluca author non-byline.; Boursier Jérôme author non-byline.; Francque Sven author non-byline.; Vonghia Luisa author non-byline.; Ekstedt Mattias author non-byline.; Kechagias Stergios author non-byline.; Yki-Jarvinen Hannele author non-byline.; Porthan Kimmo author non-byline.; Mil Saskia van author non-byline.; Papatheodoridis George author non-byline.; Cortez-Pinto Helena author non-byline.; Valenti Luca author non-byline.; Petta Salvatore author non-byline.; Miele Luca author non-byline.; Geier Andreas author non-byline.; Trautwein Christian author non-byline.; Aithal Guru author non-byline.; Hockings Paul author non-byline.; Newsome Philip author non-byline.; Wenn David author non-byline.; Rodrigues Cecília Maria author non-byline.; Chaumat Pierre author non-byline.; Hanf Rémy author non-byline.; Trylesinski Aldo author non-byline.; Ortiz Pablo author non-byline.; Duffin Kevin author non-byline.; Brosnan Julia author non-byline.; Tuthill Theresa author non-byline.; McLeod Euan author non-byline.; Ertle Judith author non-byline.; Younes Ramy author non-byline.; Ostroff Rachel author non-byline.; Alexander Leigh author non-byline.; Kjær Mette Skalshøi author non-byline.; Mikkelsen Lars Friis author non-byline.; Balp Maria-Magdalena author non-byline.; Brass Clifford author non-byline.; Jennings Lori author non-byline.; Martic Miljen author non-byline.; Loeffler Juergen author non-byline.; Hanauer Guido author non-byline.; Shankar Sudha author non-byline.; Fournier Céline author non-byline.; Pepin Kay author non-byline.; Ehman Richard author non-byline.; Myers Joel author non-byline.; Ho Gideon author non-byline.; Torstenson Richard author non-byline.; Myers Rob author non-byline.; Doward Lynda author non-byline.;
• Is Part Of: Gut. Volume 71:Issue 5(2022)
• Page Start: 1006
• Page End: 1019
• Publication Date: 2021-05-17
• Subjects: hepatic fibrosis -- fatty liver -- clinical decision making -- biostatistics; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2021-324243
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Liver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM-VCTE), Fibrosis-4 Index (FIB-4) and NAFLD (non-alcoholic fatty liver disease) Fibrosis Score (NFS) and to derive diagnostic strategies that could reduce the need for liver biopsies. Design: Individual patient data meta-analysis of studies evaluating LSM-VCTE against liver histology was conducted. FIB-4 and NFS were computed where possible. Sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Biomarkers were assessed individually and in sequential combinations. Results: Data were included from 37 primary studies (n=5735; 45% women; median age: 54 years; median body mass index: 30 kg/m 2 ; 33% had type 2 diabetes; 30% had advanced fibrosis). AUROCs of individual LSM-VCTE, FIB-4 and NFS for advanced fibrosis were 0.85, 0.76 and 0.73. Sequential combination of FIB-4 cut-offs (<1.3; ≥2.67) followed by LSM-VCTE cut-offs (<8.0; ≥10.0 kPa) to rule-in or rule-out advanced fibrosis had sensitivity and specificity (95% CI) of 66% (63–68) and 86% (84–87) with 33% needing a biopsy to establish a final diagnosis. FIB-4 cut-offs (<1.3; ≥3.48) followed by LSM cut-offs (<8.0; ≥20.0 kPa) to rule out advanced fibrosis or rule in cirrhosis had a sensitivity of 38% (37–39) and specificity of 90% (89–91) with 19% needing biopsy. Conclusion: Sequential combinations of markers with a lower cut-off to rule-out advanced fibrosis and a higher cut-off to rule-in cirrhosis can reduce the need for liver biopsies.