Premium
The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease
Author(s) -
Petta Salvatore,
Vanni Ester,
Bugianesi Elisabetta,
Di Marco Vito,
Cammà Calogero,
Cabibi Daniela,
Mezzabotta Lavinia,
Craxì Antonio
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12584
Subject(s) - nonalcoholic fatty liver disease , medicine , cohort , gastroenterology , fibrosis , fatty liver , liver disease , disease
Background & Aims The accuracy of noninvasive tools for the diagnosis of severe fibrosis in patients with nonalcoholic fatty liver disease( NAFLD ) in clinical practice is still limited. We aimed at assessing the diagnostic performance of combined noninvasive tools in two independent cohorts of Italian NAFLD patients. Methods We analysed data from 321 Italian patients(179 Sicilian‐training cohort, and 142 northern Italy‐validation cohort) with an histological diagnosis of NAFLD . Severe fibrosis was defined as fibrosis ≥ F3 according to Kleiner classification. The APRI , AST / ALT , BARD , FIB ‐4, and NFS scores were calculated according to published algorithms. Liver stiffness measurement( LSM ) was performed by FibroScan. Cut‐off points of LSM , NFS and FIB ‐4 for rule‐in or rule‐out F3‐F4 fibrosis were calculated by the reported formulas. Results In the Sicilian cohort AUC s of LSM , NFS , FIB ‐4, LSM plus NFS , LSM plus FIB ‐4, and NFS plus FIB ‐4 were 0.857, 0.803, 0.790, 0.878, 0.888 and 0.807, respectively, while in the northern Italy cohort the corresponding AUC s were 0.848, 0.730, 0.703, 0.844, 0.850, and 0.733 respectively. In the training cohort, the combination of LSM plus NFS was the best performing strategy, providing false positive, false negative and uncertainty area rates of 0%,1.1% and 48% respectively. Similar results were obtained in the validation cohort with false positive, false negative and uncertainty area rates of 0%,7.3% and 40.8%. Conclusions The combination of LSM with NFS , two complementary, easy‐to‐perform, and widely available tools, is able to accurately diagnose or exclude the presence of severe liver fibrosis, also reducing of about 50–60% the number of needed diagnostic liver biopsies.