Logo image
Back
Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage
Journal article   Open access   Peer reviewed

Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage

Nonalcoholic Steatohepatitis Clinical Research Network (NASH), Mohammad Shadab Siddiqui, Goro Yamada, Raj Vuppalanchi, Mark L Van Natta, Rohit Loomba, Cynthia Guy, Danielle Brandman, James Tonascia, Naga Chalasani, …
Clinical gastroenterology and hepatology, v 17(9), pp 1877-1885
01 Aug 2019
DOI: https://doi.org/10.1016/j.cgh.2018.12.031
PMID: 30616027
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609497View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Gastroenterology & Hepatology Life Sciences & Biomedicine Science & Technology
BACKGROUND & AIMS: Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. METHODS: We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST): platelet ratio (APRI), FIB-4, ratio of AST: alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 02 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. RESULTS: In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P <.001), 0.26 (95% CI, 0.15-0.37; P <.001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). CONCLUSIONS: In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.

Metrics

11 Record Views
208 citations in Web of Science
214 citations in Scopus

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Gastroenterology & Hepatology
Logo image