4 research outputs found
Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis
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/m2; 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
Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis
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 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 individu-ally and in sequential combinations.Results: Data were included from 37 primary studies (n=5735; 45% female; median age: 54 years; median BMI: 30 kg/m2; 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
Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
Background and Aims: Vibration-controlled transient elastography
(VCTE), point shear wave elastography (pSWE), 2-
dimensional shear wave elastography (2DSWE), magnetic resonance
elastography (MRE), and magnetic resonance imaging
(MRI) have been proposed as non-invasive tests for patients with
non-alcoholic fatty liver disease (NAFLD). This study evaluated
their diagnostic accuracy for liver fibrosis and non-alcoholic
steatohepatitis (NASH).
Methods: PubMED/MEDLINE, EMBASE and the Cochrane Library
were searched for studies examining the diagnostic accuracy of
these index tests, against histology as the reference standard, in
adult patients with NAFLD. Two authors independently screened
and assessed methodological quality of studies and extracted
data. Summary estimates of sensitivity, specificity and area under
the curve (sAUC) were calculated for fibrosis stages and
NASH, using a random effects bivariate logit-normal model.
Results: We included 82 studies (14,609 patients). Meta-analysis
for diagnosing fibrosis stages was possible in 53 VCTE, 11 MRE, 12
pSWE and 4 2DSWE studies, and for diagnosing NASH in 4 MRE
studies. sAUC for diagnosis of significant fibrosis were: 0.83 for VCTE, 0.91 for MRE, 0.86 for pSWE and 0.75 for 2DSWE. sAUC for
diagnosis of advanced fibrosis were: 0.85 for VCTE, 0.92 for MRE,
0.89 for pSWE and 0.72 for 2DSWE. sAUC for diagnosis of
cirrhosis were: 0.89 for VCTE, 0.90 for MRE, 0.90 for pSWE and
0.88 for 2DSWE. MRE had sAUC of 0.83 for diagnosis of NASH.
Three (4%) studies reported intention-to-diagnose analyses and
15 (18%) studies reported diagnostic accuracy against prespecified
cut-offs.
Conclusions: When elastography index tests are acquired successfully,
they have acceptable diagnostic accuracy for advanced
fibrosis and cirrhosis. The potential clinical impact of these index
tests cannot be assessed fully as intention-to-diagnose analyses
and validation of pre-specified thresholds are lacking.
Lay summary: Non-invasive tests that measure liver stiffness or
use magnetic resonance imaging (MRI) have been suggested as
alternatives to liver biopsy for assessing the severity of liver
scarring (fibrosis) and fatty inflammation (steatohepatitis) in
patients with non-alcoholic fatty liver disease (NAFLD). In this
study, we summarise the results of previously published studies
on how accurately these non-invasive tests can diagnose liver
fibrosis and inflammation, using liver biopsy as the reference.We
found that some techniques that measure liver stiffness had a
good performance for the diagnosis of severe liver scarring