Affiliation:
1. Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church Virginia USA
2. Center for Liver Disease, Department of Medicine Inova Fairfax Medical Campus Falls Church Virginia USA
3. Inova Medicine Service Line Inova Health System Falls Church Virginia USA
4. Center for Outcomes Research in Liver Diseases Washington District of Columbia USA
Abstract
SummaryBackgroundThe presence of fibrosis in NAFLD is the most significant risk factor for adverse outcomes. We determined the cutoff scores of two non‐invasive te sts (NITs) to rule in and rule out significant fibrosis among NAFLD patients.MethodsClinical data and liver biopsies were used for NAFLD patients included in this analysis (2001–2020). The enhanced liver fibrosis (ELF) and FIB‐4 NITs were calculated. Liver biopsies were read by a single hematopathologist and scored by the NASH CRN criteria. Significant fibrosis was defined as stage F2–F4.ResultsThere were 463 NAFLD patients included: 48 ± 13 years old, 31% male, 35% type 2 diabetes; 39% had significant fibrosis; mean ELF score was 9.0 ± 1.2, mean FIB‐4 score was 1.22 ± 1.05. Patients with significant fibrosis were older, more commonly male, had lower BMI but more components of metabolic syndrome, higher ELF and FIB‐4 (p < 0.0001). The performance of the two NITs in identifying significant fibrosis was: AUC (95% CI) = 0.78 (0.74–0.82) for ELF, 0.79 (0.75–0.83) for FIB‐4. The combination of ELF score ≥9.8 and FIB‐4 ≥ 1.96 returned a positive predictive value of 95% which can reliably rule in significant fibrosis (sensitivity 22%, specificity >99%), while an ELF score ≤7.7 or FIB‐4 ≤ 0.30 had a negative predictive value of 95% ruling out significant fibrosis (sensitivity 98%, specificity 22%).ConclusionsThe combination of ELF and FIB‐4 may provide practitioners with easily obtained information to risk stratify patients with NAFLD who could be referred to specialists or for enrollment in clinical trials.
Subject
Pharmacology (medical),Gastroenterology,Hepatology
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献