Poor Diagnostic Efficacy of Noninvasive Tests for Advanced Fibrosis in Obese or Younger Than 60 Diabetic NAFLD patients

• Published in: Clinical gastroenterology and hepatology Vol. 21; no. 4; pp. 1013 - 1022.e6
• Main Authors: Ito, Takanori, Nguyen, Vy H., Tanaka, Taku, Park, Huiyul, Yeh, Ming-Lun, Kawanaka, Miwa, Arai, Taeang, Atsukawa, Masanori, Yoon, Eileen L., Tsai, Pei-Chien, Toyoda, Hidenori, Huang, Jee-Fu, Henry, Linda, Jun, Dae Won, Yu, Ming-Lung, Ishigami, Masatoshi, Nguyen, Mindie H., Cheung, Ramsey C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Aged; Alanine Transaminase; Aspartate Aminotransferases; Biopsy; Diabetes Mellitus, Type 2 - complications; FIB-4 Index; Gastroenterology and Hepatology; Hepamet Fibrosis Score; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - pathology; NITs; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - pathology; Nonalcoholic Fatty Liver Disease; Obesity - complications; Severity of Illness Index; T2DM; AST; NAFLD; CI; ALT; AUROC; Hepamet Fibrosis Score; NASH; FIB-4 Index; HFS; EASL; NPV; Nonalcoholic Fatty Liver Disease; PPV; AASLD; FIB-4; NFS; NITs; BMI; positive predictive value; noninvasive tests; nonalcoholic steatohepatitis; alanine transaminase; type 2 diabetes mellitus; American Association for the Study of Liver Disease; area under the receiver operating characteristic; European Association for the Study of the Liver; body mass index; Fibrosis-4; NAFLD fibrosis score; aspartate aminotransferase; confidence interval; negative predictive value
• DOI: 10.1016/j.cgh.2022.05.015
• ISSN: 1542-3565; 1542-7714

Serum-based noninvasive tests (NITs) have been widely used to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). However, the diagnostic efficacy of NITs across ranges of age, body mass index (BMI), and presence of type 2 diabetes (T2DM) may vary and have not been well-characterized. We analyzed 1489 patients with biopsy-proven NAFLD from 6 centers in Japan, Taiwan, and Korea. Using histology as the gold standard, we compared the areas under the receiver operating characteristic (AUROCs) of Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and the new Hepamet fibrosis score (HFS), with a focus on performance in subgroups as stratified by age, BMI, and the presence of T2DM. By histology, 44.0% of the overall cohort (655/1489) had F2-4, and 20.6% (307/1489) had F3-4 fibrosis. FIB-4 had the highest AUROCs for both F2-4 (0.701 vs NFS 0.676 and HFS 0.682, P = .001) and F3-4 (0.767 vs NFS 0.736 and HFS 0.752, P = .002). However, for F3-4 fibrosis, the AUROCs of all 3 NITs were generally higher in older (>60 years), nonobese (BMI <25 kg/m2), and non-diabetic patients, although overall the best performance was observed with FIB-4 among nonobese (BMI<25) diabetic patients (AUROC, 0.92). The worst performance was observed in younger patients with T2DM for all NITs including FIB-4 (AUROC, 0.63–0.66). FIB-4 had higher diagnostic efficacy for F3-4 than NFS or HFS, but this varied greatly by age, BMI, and T2DM, with better performance in older, nonobese, and nondiabetic patients. However, all NITs including FIB-4 had unacceptably poor performance in young or obese diabetic patients. [Display omitted]