Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease

Katharina Staufer; Emina Halilbasic; Walter Spindelboeck; Magdalena Eilenberg; Gerhard Prager; Vanessa Stadlbauer; Andreas Posch; Petra Munda; Rodrig Marculescu; Barbara Obermayer-Pietsch; Judith Stift; Carolin Lackner; Michael Trauner; Rudolf E Stauber

doi:10.1177/2050640619865133

Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease

United European Gastroenterol J. 2019 Oct;7(8):1113-1123. doi: 10.1177/2050640619865133. Epub 2019 Jul 12.

Authors

Affiliations

¹ Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
² Department of Visceral Surgery and Medicine, University Hospital Bern, Bern, Switzerland.
³ Department of Internal Medicine, Medical University of Graz, Graz, Austria.
⁴ Department of Surgery, Medical University of Vienna, Vienna, Austria.
⁵ Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
⁶ Department of Pathology, Medical University of Vienna, Vienna, Austria.
⁷ Institute of Pathology, Medical University of Graz, Graz, Austria.

Abstract

Background: In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.

Objective: To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).

Methods: We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeter^V2G, FibroMeter^V3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).

Results: Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeter^V2G (AUROC 0.86, 0.88, 0.89), FibroMeter^V3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).

Conclusion: Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.

Keywords: Enhanced liver fibrosis score; FibroMeter; NAFLD fibrosis score; fibrosis-4 index; liver stiffness measurement; vibration-controlled transient elastography.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Austria / epidemiology
Biopsy / methods
Diagnosis, Differential
Elasticity Imaging Techniques / instrumentation
Elasticity Imaging Techniques / methods*
Female
Humans
Liver Cirrhosis / blood
Liver Cirrhosis / diagnostic imaging*
Liver Cirrhosis / mortality
Liver Cirrhosis / pathology*
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / complications
Non-alcoholic Fatty Liver Disease / epidemiology
Non-alcoholic Fatty Liver Disease / metabolism
Non-alcoholic Fatty Liver Disease / pathology*
Predictive Value of Tests
Prevalence
Prognosis
Prospective Studies
Risk Assessment
Sensitivity and Specificity