Validation of the new 2021 EASL algorithm for the noninvasive diagnosis of advanced fibrosis in NAFLD

被引:31
作者
Canivet, Clemence M. [1 ,2 ]
Costentin, Charlotte [3 ,4 ]
Irvine, Katharina M. [5 ,6 ]
Delamarre, Adele [7 ,8 ]
Lannes, Adrien [1 ,2 ]
Sturm, Nathalie [9 ]
Oberti, Frederic [1 ,2 ]
Patel, Preya J. [10 ]
Decaens, Thomas [3 ,4 ]
Irles-Depe, Marie [7 ,8 ]
Fouchard, Isabelle [1 ,2 ]
Hermabessiere, Paul [7 ,8 ]
Roux, Marine [2 ]
Barthelon, Justine [4 ]
Cales, Paul [1 ,2 ]
Powell, Elizabeth E. [6 ,11 ]
de Ledinghen, Victor [7 ,8 ]
Boursier, Jerome [1 ,2 ]
机构
[1] Ctr Hosp Univ Angers, Serv Hepatogastroenterol & Oncol Digest, 4 Rue Larrey, F-49933 Angers 09, France
[2] Univ dAngers, Lab HIFIH, UPRES EA3859, SFR 4208, Angers, France
[3] Univ Grenoble Alpes, Res Ctr UGA, Inst Adv Biosci, Inserm U 1209,CNRS 5309, Grenoble, France
[4] Ctr Hosp Univ Grenoble Alpes, Serv Hepatogastroenterol, La Tronche, France
[5] Univ Queensland, Translat Res Inst, Mater Res, Brisbane, Qld, Australia
[6] Univ Queensland, Ctr Liver Dis Res, Translat Res Inst, Brisbane, Qld, Australia
[7] Ctr Hosp Univ Bordeaux, Serv Hepatol, Hop Haut Leveque, Pessac, France
[8] Univ Bordeaux, INSERM U1312, Bordeaux, France
[9] Ctr Hosp Univ Grenoble Alpes, Serv Anat & Cytol Pathol, La Tronche, France
[10] Freeman Rd Hosp, Liver Unit, Newcastle Upon Tyne, Tyne & Wear, England
[11] Princess Alexandra Hosp, Dept Gastroenterol & Hepatol, Brisbane, Qld, Australia
关键词
CHRONIC HEPATITIS-C; LIVER FIBROSIS; BIOCHEMICAL MARKERS; BLOOD-TESTS; DISEASE; BIOPSY; RISK; PREDICTION; MANAGEMENT; MORTALITY;
D O I
10.1002/hep.32665
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims The European Association for the Study of the Liver (EASL) has recently proposed an algorithm for the diagnosis of advanced liver fibrosis. We aimed to evaluate the diagnostic accuracy of this algorithm in nonalcoholic fatty liver disease (NAFLD). Approach and Results One thousand fifty-one patients with NAFLD, liver biopsy, and four noninvasive tests (NITs; Fibrosis-4 [FIB4], vibration controlled transient elastography [VCTE], FibroMeter, Fibrotest) were included. The enhanced liver fibrosis (ELF) score was available in 396 patients. A cohort of 230 patients from primary care/diabetes clinics had FIB4, VCTE, and ELF. Compared with the performance of single NITs, agreement between two NITs (FIB4 and VCTE, VCTE and patented serum tests) increased specificity and positive predictive value by 20%, thus justifying the sequential use proposed in the EASL algorithm. The FIB4/VCTE/FibroMeter and FIB4/VCTE/Fibrotest algorithms performed similarly, providing 85% diagnostic accuracy and a liver biopsy requirement rate of only 10%. The FIB4/VCTE/ELF algorithm performed similarly in the subgroup where ELF was available. Simulations of algorithm accuracies at different prevalence showed that positive predictive values rapidly increased, reaching a plateau above 75% starting at 15% prevalence. Negative predictive values remained higher than 90% up to 25% prevalence. The rate of liver biopsy requirement remained stable, increasing by only 5% between low and high prevalence settings. When the EASL algorithm was applied in the primary care/diabetes clinic cohort, liver biopsy requirement was only 3%, and the agreement among the three steps provided 75% positive predictive value. Conclusions Our study validates the algorithm proposed by the EASL in its latest 2021 guidelines for the diagnosis of advanced fibrosis in the setting of NAFLD.
引用
收藏
页码:920 / 930
页数:11
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