976 Fibroscan™, FIB-4, and NAFLD Fibrosis Score as Point of Care Non-Invasive Tests for Management of Non-Alcoholic Fatty Liver Disease and Other Chronic Liver Diseases

• Published in: The American journal of gastroenterology Vol. 114; no. 1; pp. S567 - S568
• Main Authors: Younossi, Zobair, Stepanova, Maria, Felix, Sean, Jeffers, Tom, Younossi, Elena, Allawi, Hossain, Cable, Rebecca, Lam, Brian, Racila, Andrei, Younossi, Issah, Henry, Linda, Ranagan, Jane, Nader, Fatema
• Format: Journal Article
• Language: English
• Published: 01.10.2019
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/01.ajg.0000593440.74586.b2

INTRODUCTION: Fibroscan™ (FS) is a clinically useful tool for non-invasive assessment of fibrosis in patients with chronic liver disease (CLD). We aimed to assess the performance of FS as a point-of-care testing in real clinical practice of gastroenterology/hepatology. METHODS: During routine outpatient visits, patients with various etiologies of CLD had FS administered and laboratory tests collected. Advanced fibrosis was defined as a liver stiffness of ≥11.4 kPa and advanced steatosis as a controlled attenuation parameter (CAP) ≥ 260 dB/m. Non-invasive test (NIT) scores were calculated for fibrosis: FIB-4 (advanced fibrosis in patients with the score ≥ 2.67), AST-to-Platelet Ratio (APRI; advanced fibrosis ≥ 1.0), NAFLD Fibrosis Score (NFS; advanced fibrosis ≥ 0.676). Patients with advanced fibrosis status by NITs and a subgroup with liver biopsy data were used for concordance assessment (Cohen’s kappa statistic; Table 1) with FS for each major CLD etiology. Another subgroup of patients had FS administered twice (median period 12 months); these data were used to assess test-retest concordance of FS. RESULTS: There were 416 patients included: 28 with chronic hepatitis B (CHB), 32 with chronic hepatitis C (CHC), 270 with non-alcoholic fatty liver disease (NAFLD). Patients were 53.4 ± 12.7 years old, 47% male, 59% white, 12% black, 10% Hispanic, 10% Asian, 33% with type 2 diabetes. Patients with CHC had the highest mean liver stiffness (12.8 ± 13.4 kPa vs. 7.9 ± 7.0 kPa in others, P = 0.0006) while patients with NAFLD had the highest CAP (308 ± 51 dB/m vs. 258 ± 64 dB/m, P < 0.00001). The test-retest concordance for advanced fibrosis by FS was substantial [kappa = 0.70 (0.43–0.97),agreement in 45 out of 49 patients] and moderate for advanced steatosis [kappa was 0.41 (0.12–0.79),agreement in 38/49 patients]. In patients with CHC, the highest concordance of advanced fibrosis by FS was by FIB-4 [kappa = 0.58 (0.25–0.91)] and APRI [0.46 (0.12–0.81)]. Similarly, in patients with NAFLD, the highest concordance of advanced fibrosis by FS was with the stage of histologic fibrosis by liver biopsy [N = 66: kappa = 0.55 (0.35–0.74)] and NFS [kappa = 0.50 (0.32–0.67)]. CONCLUSION: Non-invasive tests such as Fibroscan ™ , NFS, and FIB-4 provide useful information for assessment of advanced fibrosis in clinical practice of patients with CLD.