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Serial combination of non‐invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD
Author(s) -
Petta S.,
Wong V. W.S.,
Cammà C.,
Hiriart J.B.,
Wong G. L.H.,
Vergniol J.,
Chan A. W.H.,
Di Marco V.,
Merrouche W.,
Chan H. L.Y.,
Marra F.,
LeBail B.,
Arena U.,
Craxì A.,
Ledinghen V.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14219
Subject(s) - medicine , nonalcoholic fatty liver disease , fibrosis , gastroenterology , liver fibrosis , diagnostic accuracy , fatty liver , pathology , disease
Summary Background The accuracy of available non‐invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease ( NAFLD ) is still limited. Aim To assess the diagnostic performance of paired or serial combination of non‐invasive tools in NAFLD patients. Methods We analysed data from 741 patients with a histological diagnosis of NAFLD . The GGT / PLT , APRI , AST / ALT , BARD , FIB ‐4, and NAFLD Fibrosis Score ( NFS ) scores were calculated according to published algorithms. Liver stiffness measurement ( LSM ) was performed by FibroScan. Results LSM , NFS and FIB ‐4 were the best non‐invasive tools for staging F3‐F4 fibrosis ( AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB ‐4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB ‐4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB ‐4 values (<−1.455 and <1.30, respectively) overall increased the diagnostic performance generating an accuracy ranging from 69.8% to 70.1%, an uncertainty area ranging from 18.9% to 20.4% and a rate of wrong classification ranging from 9.2% to 11.3%. Conclusion The serial combination of LSM with FIB ‐4/ NFS has a good diagnostic accuracy for the non‐invasive diagnosis of severe fibrosis in NAFLD .