A sequential approach using the age‐adjusted fibrosis‐4 index and vibration‐controlled transient elastography to detect advanced fibrosis in Korean patients with non‐alcoholic fatty liver disease

瞬态弹性成像 医学 纤维化 内科学 胃肠病学 脂肪肝 接收机工作特性 肝硬化 非酒精性脂肪肝 肝活检 糖尿病 脂肪性肝炎 肝病 活检 肝纤维化 疾病 内分泌学
作者
Dong Hyeon Lee,Se Un Sung,Yun Kyu Lee,Ik Hyeon Lim,Heejoon Jang,Sae Kyoung Joo,Jeong Hwan Park,Mee Soo Chang,Young So,Won Kim
出处
期刊:Alimentary Pharmacology & Therapeutics [Wiley]
卷期号:55 (8): 994-1007 被引量:6
标识
DOI:10.1111/apt.16766
摘要

Vibration-controlled transient elastography (VCTE) has shown good diagnostic performance in predicting fibrosis stages in patients with non-alcoholic fatty liver disease (NAFLD). However, an optimal diagnostic approach to detect advanced fibrosis in patients with NAFLD has not been established.We prospectively collected data from 539 subjects who underwent liver biopsy at a single centre between January 2014 and December 2019. Diagnostic performance was estimated using the area under the receiver-operating characteristic curve (AUROC). Several models combining the fibrosis 4 index (FIB-4) score and liver stiffness measurement (LSM) were analysed to reduce the need for unnecessary liver biopsies. We observed significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) in 173 (32.1%), 74 (13.7%) and 46 subjects (8.5%), respectively. The AUROCs (95% CI) for LSMs to diagnose ≥F2, ≥F3 and F4 were 0.82 (0.78-0.85), 0.92 (0.89-0.94) and 0.95 (0.93-0.97), respectively. Optimal LSM cut-off values were 6.7 (≥F2), 8.3 (≥F3) and 9.8 (F4) kPa. LSMs were affected by waist circumference, serum albumin and fibrosis stage (R2 = 0.315). Abdominal obesity, elevated transaminase, diabetes mellitus and high IQR/Median were associated with the discordance of ≥2 fibrosis stages between LSMs and histologic data. The sequential use of the age-adjusted FIB-4 and LSMs yielded the least uncertainty (5.3%) in classifying disease severity with the highest diagnostic accuracy (81%) among a variety of non-invasive test combinations.The sequential approach of age-adjusted FIB-4 and VCTE could represent a practical diagnostic strategy to detect advanced fibrosis in NAFLD (ClinicalTrials.gov #NCT02206841).

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