The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Performance of Noninvasive Liver Fibrosis Tests in Morbidly Obese Patients with Nonalcoholic Fatty Liver Disease
Obes Surg. 2021 Feb 22. doi: 10.1007/s11695-020-04996-1. Online ahead of print.
Saleh A Alqahtani123, Pegah Golabi45, James M Paik45, Brian Lam4, Amir H Moazez5, Hazem A Elariny5, Zachary Goodman4, Zobair M Younossi67
Author information
1Center for Outcomes Research in Liver Diseases, Wasshington DC, 20037, USA.
2Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, 21218, USA.
3King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
4Center For Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, 22042, USA.
5Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA.
6Center For Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, 22042, USA. Zobair.Younossi@inova.org.
7Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA. Zobair.Younossi@inova.org.
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in morbidly obese patients, and fibrosis is an independent predictor of mortality. Noninvasive tests (NITs) are being developed for the detection of advanced fibrosis (AF).
Purpose: To assess the performance of three NITs (NAFLD fibrosis score, NFS, fibrosis-4 index, FIB-4, and aspartate aminotransferase-to-platelet ratio, APRI), in the identification of AF among morbidly obese patients.
Materials and methods: Patients, who underwent bariatric surgery between 2004 and 2009 and had liver biopsy, were included. Fibrosis stages ≥ F2 and ≥ F3 were defined as significant and AF, respectively. Published and optimal thresholds (Youden index) for NFS, FIB-4 and APRI, sensitivity, specificity, positive and negative predictive values (PPV-NPV), and area under the receiver operator curves (AUROC) were evaluated.
Results: Among 584 patients (mean age 43.3 ± 11.3 years, 21.2% male, 75% white, mean BMI 45.5 ± 8.80), 31.7% had NASH. Stages distributions were F1 = 68.1%, F2 = 16.4%, F3 = 8%, and F4 = 3.2%. At published thresholds, all 3 NITs performed poorly for detection of AF, with AUROC < 0.62. Overall performance at optimal thresholds improved to 0.68, 0.72, and 0.74 for NFS, FIB-4, and APRI, respectively. At optimal thresholds, all tests had good NPV (94.4-95.9%) but low PPV (24.2-32.5%). Combinations of the tests did not improve their performance.
Conclusions: NFS, FIB-4, and APRI fall short to detect advanced fibrosis but valuable for excluding advanced fibrosis. More research is needed to develop new NITs with high positive predictive value.