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Serum biomarkers can predict a change in liver fibrosis 1 year after lifestyle intervention for biopsy‐proven NASH
Author(s) -
VilarGomez Eduardo,
CalzadillaBertot Luis,
Friedman Scott L.,
GraOramas Bienvenido,
GonzalezFabian Licet,
Lazodel Vallin Sacha,
Diago Moises,
Adams Leon A.
Publication year - 2017
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.13480
Subject(s) - fibrosis , medicine , gastroenterology , liver fibrosis , hepatic fibrosis , liver biopsy , platelet , biopsy , pathology
Background & Aims The dynamic response of serum fibrosis biomarkers to histological changes within the liver following lifestyle intervention ( LI ) is unknown. We explored relationships between changes in serum biomarkers and liver fibrosis in NASH patients undergoing LI . Methods Paired liver biopsies were performed in 261 NASH patients to assess fibrosis change after 1 year of LI . We explored the utility of serum fibrosis markers to predict changes in hepatic fibrosis and developed and internally validated a model for predicting fibrosis improvement in patients with baseline fibrosis. Results Regression, stabilization and worsening of fibrosis occurred in 51 (20%), 165 (63%) and 45 (17%) patients respectively. By multivariable analysis, change in HbA1c ( OR , 0.39, P <.01), platelets ( OR , 1.22, P <.01) and NFS ( OR , 0.27, P <.01), as well as ALT normalization ( OR , 9.7, P <.01) were independently associated with fibrosis improvement, whereas change in platelets ( OR , 0.96, P <.01), and NFS ( OR , 1.8, P <.01) as well as ALT normalization ( OR , 0.21, P <.01) were linked to fibrosis progression. A model, including change in HbA1c, platelet and ALT normalization, was significantly more accurate ( AUC of 0.96, 95% CI , l0.94‐0.99) than NFS , FIB ‐4 and APRI for predicting fibrosis improvement. Using a threshold of ≥0.497, positive and negative predictive values were 94% (95% CI , 84‐98) and 91% (95% CI , 81‐96) respectively. Conclusions Change in NFS , platelets and ALT normalization are associated with change in liver fibrosis after 1 year of LI . A model including change in HbA1c, platelet and ALT normalization discriminated patients with fibrosis improvement significantly better than other biomarkers.