10 research outputs found
A Senior Recital: All\u27s Fair in Love & War
Full text linkProgram listing performers and works performe
Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease : an individual participant data meta-analysis
No full textAbstract: Background Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. Methods This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0\u20134), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score 6515). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0\u20132 vs F3 vs F4; LSM: 2\ub767; NFS: 0\ub7676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. Findings Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44\ub77%] were female, median age was 54 years [IQR 44\u201363), and 1161 [46\ub71%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33\u201391], the composite endpoint was observed in 145 (5\ub78%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0\ub70001 for all comparisons). The tAUC at 5 years were 0\ub772 (95% CI 0\ub762\u20130\ub781) for histology, 0\ub776 (0\ub770\u20130\ub783) for LSM-VCTE, 0\ub774 (0\ub764\u20130\ub782) for FIB-4, and 0\ub770 (0\ub763\u20130\ub780) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. Interpretation Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases
