External Validation of Serologic Scores for the Detection of Liver Steatosis Among People With HIV
Author:
Riebensahm Carlotta123ORCID, Brocker Julia1, Berzigotti Annalisa45, Günthard Huldrych F67, Tarr Philip E8, Furrer Hansjakob1ORCID, Rauch Andri1ORCID, Wandeler Gilles13ORCID, Surial Bernard1ORCID, , Abela I, Aebi-Popp K, Anagnostopoulos A, Battegay M, Bernasconi E, Braun D L, Bucher H C, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux C A, Günthard H F, Hachfeld A, Haerry D, Hasse B, Hirsch H H, Hoffmann M, Hösli I, Huber M, Jackson-Perry D, Kahlert C R, Keiser O, Klimkait T, Kouyos R D, Kovari H, Kusejko K, Labhardt N, Leuzinger K, Martinez de Tejada B, Marzolini C, Metzner K J, Müller N, Nemeth J, Nicca D, Notter J, Paioni P, Pantaleo G, Perreau M, Rauch A, Salazar-Vizcaya L, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Wandeler G, Weisser M, Yerly S
Affiliation:
1. Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland 2. Graduate School of Health Sciences, University of Bern , Bern , Switzerland 3. Institute of Social and Preventive Medicine, University of Bern , Bern , Switzerland 4. Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland 5. Hepatology, Department of BioMedical Research, University of Bern , Bern , Switzerland 6. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich , Zurich , Switzerland 7. Institute of Medical Virology, University of Zurich , Zurich , Switzerland 8. University Center for Internal Medicine, Kantonsspital Baselland, University of Basel , Bruderholz , Switzerland
Abstract
Abstract
Background
Fatty liver index (FLI) and hepatic steatosis index (HSI) are serologic scores used to detect liver steatosis. However, their diagnostic performance in people with HIV (PWH) remains unclear. We performed an external validation of FLI and HSI in the Swiss HIV Cohort Study.
Methods
We systematically performed vibration-controlled transient elastography (VCTE) among Swiss HIV Cohort Study participants at Bern University Hospital between November 2019 and August 2021. Individuals with viral hepatitis and pregnant women were excluded. We defined liver steatosis as controlled attenuation parameter ≥248 dB/m using VCTE. Model discrimination was assessed with the C-index and model calibration with calibration plots. A decision curve analysis was performed to compare the clinical usefulness of both scores.
Results
Of 321 participants, 91 (28.4%) were female, the median age was 51.4 years (IQR, 42–59), 230 (71.7%) were Caucasian, and 164 (51.1%) had a body mass index >25 kg/m2. VCTE-confirmed liver steatosis was present in 158 (49.2%). Overall, 125 (38.9%) had an FLI ≥60, and 128 (39.9%) had an HSI ≥36. At these cutoffs, the C-index to diagnose liver steatosis was 0.85 for FLI (95% CI, .80–.89) and 0.78 for HSI (95% CI, .73–.83). Whereas FLI was well calibrated, HSI overestimated the risk for steatosis. Both models showed a positive net benefit, with FLI having a greater net benefit when compared with HSI.
Conclusions
FLI and HSI are valid tools to detect liver steatosis in PWH. FLI should be the preferred score, given its better performance and greater clinical usefulness.
Funder
SHCS Swiss National Science Foundation SHCS research foundation Protected Research Time University of Bern
Publisher
Oxford University Press (OUP)
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