TY - JOUR
T1 - Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: An individual patient data meta-analysis
AU - Mózes, Ferenc Emil
AU - Lee, Jenny A.
AU - Selvaraj, Emmanuel Anandraj
AU - Jayaswal, Arjun Narayan Ajmer
AU - Trauner, Michael
AU - Boursier, Jerome
AU - Fournier, C. line
AU - Staufer, Katharina
AU - Stauber, Rudolf E.
AU - Bugianesi, Elisabetta
AU - Younes, Ramy
AU - Gaia, Silvia
AU - Lupșor-Platon, Monica
AU - Petta, Salvatore
AU - Shima, Toshihide
AU - Okanoue, Takeshi
AU - Mahadeva, Sanjiv
AU - Chan, Wah-Kheong
AU - Eddowes, Peter J.
AU - Newsome, Philip Noel
AU - Wong, Vincent Wai-Sun
AU - de Ledinghen, Victor
AU - Fan, Jiangao
AU - Shen, Feng
AU - Cobbold, Jeremy F.
AU - Sumida, Yoshio
AU - Okajima, Akira
AU - Schattenberg, J. rn M.
AU - Labenz, Christian
AU - Kim, Won
AU - Lee, Myoung Seok
AU - Wiegand, Johannes
AU - Karlas, Thomas
AU - Yılmaz, Yusuf
AU - Aithal, Guruprasad Padur
AU - Palaniyappan, Naaventhan
AU - Cassinotto, Christophe
AU - Aggarwal, Sandeep
AU - Garg, Harshit
AU - Ooi, Geraldine J.
AU - Nakajima, Atsushi
AU - Yoneda, Masato
AU - Ziol, Marianne
AU - Barget, Nathalie
AU - Geier, Andreas
AU - Bossuyt, Patrick M.
AU - Bossuyt, Patrick
AU - Zafarmand, Hadi
AU - Vali, Yasaman
AU - LITMUS Investigators
AU - van Mil, Saskia
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85106947127&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/gutjnl-2021-324243
DO - https://doi.org/10.1136/gutjnl-2021-324243
M3 - Article
C2 - 34001645
SN - 0017-5749
JO - Gut
JF - Gut
M1 - 324243
ER -