Open AccessNovel reliability criteria for controlled attenuation parameter assessments for non‐invasive evaluation of hepatic steatosis
Author(s) -
Semmler Georg,
Wöran Katharina,
Scheiner Bernhard,
Unger Lukas Walter,
Paternostro Rafael,
Stift Judith,
Schwabl Philipp,
Bucsics Theresa,
Bauer David,
Simbrunner Benedikt,
Stättermayer Albert Friedrich,
Pinter Matthias,
Trauner Michael,
Reiberger Thomas,
Mandorfer Mattias
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640619900820
Subject(s) - medicine , steatosis , fatty liver , gastroenterology , confidence interval , cohort , receiver operating characteristic , liver biopsy , area under the curve , liver disease , biopsy , disease
Background There is conflicting evidence regarding reliability criteria for the controlled attenuation parameter (CAP; a marker for hepatic steatosis [HS]). Thus, we assessed the diagnostic performance of CAP according to different reliability criteria based on real‐world data from an academic centre. Methods Patients undergoing measurement of CAP and liver biopsy (±6 months) at the Medical University of Vienna were included. HS was assessed according to SAF score. Results In total 319 patients were included. The main aetiologies were non‐alcoholic fatty liver disease (NAFLD, n = 177, 55.5%), viral hepatitis ( n = 49, 15.4%), and alcoholic liver disease (ALD, n = 29, 9.1%). Histological steatosis and fibrosis stages were: S0: 93 (29.2%), S1: 100 (31.3%), S2: 67 (21.0%), and S3: 59 (18.5%); F0/F1: 150 (47.0%), F2: 47 (14.7%), and F3/F4: 122 (48.3%). In the overall cohort, the area under the receiver operating characteristic curve (AUC) of CAP was 0.843 (95% confidence interval [CI]: 0.798–0.887) for diagnosing HS ≥ S1), 0.789 (95%CI: 0.740–0.839) for ≥S2, and 0.767 (95%CI: 0.712–0.823) for S3. CAP corrections as suggested by Karlas et al. did not improve the diagnostic performance. Importantly, the AUC of CAP for HS ≥ S1 was numerically highest in patients with CAP‐IQR/median<0.10 or <0.20 (obtained in 37.9% and 74.9%), in whom CAP also had better diagnostic performance, as compared with patients not meeting these criteria. Moreover, it was substantially higher in 288 (90.3%) patients with CAP‐IQR/median<0.3: 0.856 (95%CI: 0.809–0.903) vs. patients not meeting this criterion (0.530 [95%CI: 0.309–0.751]). In contrast, the previously suggested reliability criterion of CAP‐IQR<40 dB/m was not associated with an improved diagnostic performance for HS≥S1 (0.866 [95%CI: 0.812–0.920] vs. 0.799 [95%CI: 0.717–0.881]) and was only obtained in 199 (62.4%) patients. Conclusion CAP‐IQR/median<0.1, <0.2, and <0.3 identify reliable measurements for diagnosing any hepatic steatosis (≥S1). Importantly, CAP‐IQR/median<0.3 has a considerably higher applicability in clinical practice, as compared with the previously suggested CAP‐IQR<40 dB/m criterion.