Diagnostic accuracy of controlled attenuation parameter (CAP) as a non-invasive test for steatosis in suspected non-alcoholic fatty liver disease: a systematic review and meta-analysis

• Published in: BMC gastroenterology Vol. 19; no. 1; pp. 51 - 11
• Main Authors: Pu, Ke, Wang, Yuping, Bai, Suyang, Wei, Hui, Zhou, Yongning, Fan, Jiangao, Qiao, Liang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.04.2019; BioMed Central; BMC
• Subjects: Accuracy; Biopsy; Body mass index; Controlled attenuation parameter (CAP); Data processing; Diagnosis; Elasticity Imaging Techniques - methods; Enzymes; Fatty liver; Gastroenterology; Hepatic steatosis, diagnostic accuracy; Hepatocellular carcinoma; Humans; Liver diseases; Medical imaging; Medical research; Meta-analysis; NMR; Non-alcoholic fatty liver disease (NAFLD); Non-alcoholic Fatty Liver Disease - diagnostic imaging; Non-alcoholic Fatty Liver Disease - pathology; Nuclear magnetic resonance; Risk factors; ROC Curve; Sensitivity and Specificity; Steatosis; Studies; Systematic review; Transient elastography; Ultrasonic imaging; China; Hepatic steatosis, diagnostic accuracy; Transient elastography; Controlled attenuation parameter (CAP); Non-alcoholic fatty liver disease (NAFLD)
• DOI: 10.1186/s12876-019-0961-9
• ISSN: 1471-230X

Controlled attenuation parameter (CAP) is a non-invasive method for diagnosing hepatic steatosis. Despite good diagnostic performance, clinical application of CAP is limited due to the influences of covariates. Here, a systematic review on the performance of CAP in the diagnosis and staging of hepatic steatosis in NAFLD patients was performed. The sensitivity, specificity, diagnostic odds ratio (DOR) and area under receiver operating characteristics (AUROC) curves of the pooled data for CAP in diagnosing and staging the mild (Stage 1), moderate (Stage 2) and severe (Stage 3) steatosis in NAFLD patients were assessed. The clinical utility of CAP was evaluated by Fagan plot. Heterogeneity was explored using subgroup analysis. Nine studies involving 1297 patients with liver biopsy-proven NAFLD were analyzed. The pooled sensitivity of CAP in detecting mild hepatic steatosis was 87% with a specificity of 91% and a DOR of 84.35. The pooled sensitivity of CAP in detecting moderate hepatic steatosis was 85% with a specificity of 74% and a DOR of 21.28. For severe steatosis, the pooled sensitivity was 76% with a specificity of 58% and a DOR of 4.70. The mean AUROC value for CAP in the diagnosis of mild, moderate, and severe steatosis was 0.96, 0.82 and 0.70, respectively. A subgroup analysis indicated that variation in the geographic regions, cutoffs, age and body mass index (BMI) could be the potential sources of heterogeneity in the diagnosis of moderate to severe steatosis. CAP should be cautiously considered as a non-invasive substitute for liver biopsy in clinical practice.