Forlano, R

Giannakeas, N

Goldin, R

Khan, S

Khelifa, M

Lloyd, J

Manousou, P

Mullish, BH

Okaole, A

Taylor-Robinson, S

Thursz, M

Tsipouras, MG

Tzallas, AT

Yee, M

English

Spiral - Imperial College Digital Repository

MR-281Assessment of non invasive markers of fibrosis against collagen quantitation and NASH-CRN scoring in liverbiopsies of NAFLD patientsRoberta Forlano* 1, Benjamin H. Mullish1, Nikolaos Giannakeas2, Alexandros Tzallas2, Markos Tsipouras3, Michael Yee1,Simon  Taylor-Robinson1, Jo Lloyd4, Robert Goldin4, Mark Thursz1, Pinelopi Manousou11Department of Hepatology, Imperial College, London, United Kingdom, 2Departmenf of Computer Engineering,Technological Educational Institute, Epirus, 3Department of Informatics and Telecommunication Engineering, Greece,Greece, Greece, 4Department for Cellular Pathology, Imperial College, London, United KingdomCorresponding author’s email: robertaforl@gmail.comDo you want to apply for a YI Bursary?: YesPlease indicate your date of birth (DD.MM.YYYY): 09.05.1987Introduction: Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of chronic liver disease worldwide, with anestimated global prevalence of ~25%. Whilst liver biopsy is regarded as the reference standard for staging, it has significantlimitations. Given the huge burden of NAFLD, there is much interest into the role of non-invasive assessment of fibrosis.Aims: We compare non-invasive markers of fibrosis against semi-quantitative histology and collagen quantitation.Material and Methods: We retrospectively assessed all consecutive patients with biopsy-proven NAFLD followed-up at the LiverUnit of St. Mary’s Hospital, from January 2010 to December 2016. The AST to platelet ratio Index (APRI), BARD Score, FIB-4 andNAFLD Fibrosis Score (NFS) were calculated at the time of liver biopsyand Liver Stiffness Measurements (LSM) were obtainedwithin 3 months from the biopsy. Liver biopsies were both scoredusing semi-quantitative scoring (NASH CRN scoring system) andautomated image analysis based on machine learning for the quantitation offibrosis,expressed as Collagen Proportional Area (CPA).AUROCs were calculated to diagnose fibrosis stage and CPA.Results: 238 patients with median age 50 ±13 years and median BMI 30.7±5.3 kg/m2 were included. 185 NASH and 118 advancedfibrosis (F3-F4). When semi-quantitative assessment was used as reference, LSM and FIB-4 showed the best AUROCs fordiagnosing ≥F3 (0.79,95%IC=0.69-0.91 and 0.75 95%IC=0.62-0.9), followed by BARD score (0.7,95%IC=0.55-0.81), NFS(0.65,95%IC=0.54-0.73) and APRI (0.6, 95%IC=0.5-0.69) (Figure 1). Using quantitative assessment as reference, LSM and NFSperformed better (AUROCs 0.77,95%IC=0.63-0.89 and 0.71,95%IC=0.62-0.79) to diagnose CPA>5%, followed by BARD score(0.7,95%IC=0.61-0.78), FIB-4 (0.65,95%IC=0.49-0.69) and APRI (0.51,95%IC=0.39-0.61) (Figure1). Similarly, LSM and NFSAUROCS to diagnose CPA≥12% were 0.77 (95%IC=0.69-0.75) and 0.71 (95%IC=0.65-0.82), followed by FIB-4 and BARD(0.62,95%IC=0.51-0.62 and 0.61,95%IC=0.5-0.61) (Figure 2). PPV have been overall below 60%, while LSM and NFS showedexcellent NPV: for CPA≥5% (NPV 81% and 88%) and for CPA≥12% (NPV 87% and 89%).Conclusions: LSM remains the best surrogate marker for predicting advanced fibrosis. Quantitation of collagen in liver biopsiessuggests that NFS performs better than FIB-4, with the latest performing better when NASH-CRN scoring is used. An algorithminvolving both NFS and FIB-4 score should be used to stratify patients at risk of advanced fibrosis.Disclosure of Interest: None Declared

Assessment of non invasive markers of fibrosis against collagen quantitation and NASH-CRN scoring in liver biopsies of NAFLD patients

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Assessment of non invasive markers of fibrosis against collagen quantitation and NASH-CRN scoring in liver biopsies of NAFLD patients

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