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Abstract Details
Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET-NASH Study
Hepatol Commun. 2021 Feb 21;5(6):938-946. doi: 10.1002/hep4.1689. eCollection 2021 Jun.
A Sidney Barritt1, Stephanie Watkins2, Norman Gitlin3, Samuel Klein4, Anna S Lok5, Rohit Loomba6, Cheryl Schoen2, K Rajender Reddy7, Huy Ngoc Trinh8, Andrea R Mospan2, Miriam B Vos9, L Michael Weiss10, Kenneth Cusi11, Brent A Neuschwander-Tetri12, Arun J Sanyal13
Author information
1Division of Gastroenterology and Hepatology UNC Liver Center University of North Carolina at Chapel Hill Chapel Hill NC USA.
2Target RWE Durham NC USA.
3Atlanta Gastroenterology Associates Atlanta GA USA.
4Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine Washington University School of Medicine St. Louis MO USA.
5Division of Gastroenterology and Hepatology University of Michigan Ann Arbor MI USA.
6Division of Gastroenterology Department of Medicine University of California at San Diego CA USA.
7Division of Gastroenterology and Hepatology University of Pennsylvania Philadelphia PA USA.
8San Jose Gastroenterology San Jose CA USA.
9School of Medicine Emory University Children's Healthcare of Atlanta Atlanta GA USA.
10Gastro Florida Clearwater FL USA.
11Division of Endocrinology, Diabetes and Metabolism University of Florida Gainesville FL USA.
12Division of Gastroenterology and Hepatology Saint Louis University St. Louis MO USA.
13Division of Gastroenterology, Hepatology and Nutrition Department of Internal Medicine Virginia Commonwealth University VCU Medical Center-MCV Campus West Hospital Richmond VA USA.
Abstract
Much of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy-based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real-world practice. Adults from TARGET-NASH were included in this study. Descriptive statistics are provided for the cohort and compare the characteristics of histologic NAFLD versus patients with clinically diagnosed NAFLD, followed by logistic regression and machine-learning models to describe predictors of liver biopsy. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were White, and median body mass index was 32 kg/m2. Using histologic and/or clinical criteria, a diagnosis of nonalcoholic steatohepatitis was made in 37%, and cirrhosis in 33%. Comorbid conditions included cardiovascular disease (19%), mental health diagnoses (49%), and osteoarthritis (10%). Predictors of a biopsy diagnosis included White race, female sex, diabetes, and elevated alanine aminotransferase (ALT). ALT increased the odds of liver biopsy by 14% per 10-point rise. Machine-learning analyses showed non-White patients with ALT <69 had only a 0.06 probability of undergoing liver biopsy. ALT was the dominant variable that determined liver biopsy. Conclusions: In this real-world cohort of patients with NAFLD, two-thirds of patients did not have a liver biopsy. These patients were more likely to be non-White, older, with a normal ALT, showing potential gaps in or knowledge about this population.