Compensated Advanced Chronic Liver Disease in Nonalcoholic Fatty Liver Disease: Two-Step Strategy is Better than Baveno Criteria.
Decompensation
Fibrosis
MAFLD
Metabolic syndrome
Portal hypertension
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
28
01
2022
accepted:
23
05
2022
pubmed:
8
6
2022
medline:
16
3
2023
entrez:
7
6
2022
Statut:
ppublish
Résumé
Advanced fibrosis and cirrhosis (compensated advanced chronic liver disease [cACLD]) are clinically indistinguishable and increase risk of developing clinically significant portal hypertension. Baveno VII recommends using elastography to rule out and diagnose cACLD with liver stiffness measurement (LSM) cut-offs of 10/15 kPa. In a retrospective analysis of 330 nonalcoholic fatty liver disease (NAFLD) patients, performance of the Baveno VII cut-offs for diagnosing cACLD was compared with newly suggested lower cut-offs (8/12 kPa). A model for detecting cACLD among those with LSM between 8 and 12 kPa was developed and compared with recently published models. Seventy (21.2%) of the 330 NAFLD patients had biopsy-proven cACLD. The Baveno VII cut-offs (10/15 kPa) had a lower sensitivity of 72.8% (60.9-82.8%) and a specificity of 93.4% (89.7-96.1%). Sensitivity and specificity of lower cut-offs (8/12 kPa) were 91.4% (82.3-96.8%) and 88.5% (83.9-92.1%), respectively. Modeling based on the presence of diabetes (odds ratio [OR] 3.625[1.161-11.320], p = 0.027) and serum aspartate aminotransferase (AST) levels (OR 1.636[1.098-2.436], p = 0.015) correctly identified 75.7% of patients with LSM between 8 and 12 kPa. Our model performed best with an area under receiver operator curve (AUROC) of 0.725 (95%CI 0.609-0.822), compared to Papatheodoridi (AUROC 0.626, CI 0.506-.736) and Zhou (AUROC 0.523, CI 0.403-0.640) models. A two-step strategy comprising application of lower LSM cut-offs followed by the predictive model correctly identified the presence of cACLD in 83% of the patients as compared to 75% by the Baveno VII cut-offs. A two-step strategy employing lower LSM cut-offs and modeling based on diabetes and AST levels outperforms Baveno VII cut-offs for identifying cACLD in NAFLD patients.
Sections du résumé
BACKGROUND
Advanced fibrosis and cirrhosis (compensated advanced chronic liver disease [cACLD]) are clinically indistinguishable and increase risk of developing clinically significant portal hypertension. Baveno VII recommends using elastography to rule out and diagnose cACLD with liver stiffness measurement (LSM) cut-offs of 10/15 kPa.
METHODS
In a retrospective analysis of 330 nonalcoholic fatty liver disease (NAFLD) patients, performance of the Baveno VII cut-offs for diagnosing cACLD was compared with newly suggested lower cut-offs (8/12 kPa). A model for detecting cACLD among those with LSM between 8 and 12 kPa was developed and compared with recently published models.
RESULTS
Seventy (21.2%) of the 330 NAFLD patients had biopsy-proven cACLD. The Baveno VII cut-offs (10/15 kPa) had a lower sensitivity of 72.8% (60.9-82.8%) and a specificity of 93.4% (89.7-96.1%). Sensitivity and specificity of lower cut-offs (8/12 kPa) were 91.4% (82.3-96.8%) and 88.5% (83.9-92.1%), respectively. Modeling based on the presence of diabetes (odds ratio [OR] 3.625[1.161-11.320], p = 0.027) and serum aspartate aminotransferase (AST) levels (OR 1.636[1.098-2.436], p = 0.015) correctly identified 75.7% of patients with LSM between 8 and 12 kPa. Our model performed best with an area under receiver operator curve (AUROC) of 0.725 (95%CI 0.609-0.822), compared to Papatheodoridi (AUROC 0.626, CI 0.506-.736) and Zhou (AUROC 0.523, CI 0.403-0.640) models. A two-step strategy comprising application of lower LSM cut-offs followed by the predictive model correctly identified the presence of cACLD in 83% of the patients as compared to 75% by the Baveno VII cut-offs.
CONCLUSION
A two-step strategy employing lower LSM cut-offs and modeling based on diabetes and AST levels outperforms Baveno VII cut-offs for identifying cACLD in NAFLD patients.
Identifiants
pubmed: 35670897
doi: 10.1007/s10620-022-07579-5
pii: 10.1007/s10620-022-07579-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1016-1025Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Augustin S, Pons M, Santos B, Ventura M, Genescà J. Identifying compensated advanced chronic liver disease: when (not) to start screening for varices and clinically significant portal hypertension. In: de Franchis R, ed. Berlin: Springer; 2016; 39–49. https://doi.org/10.1007/978-3-319-23018-4_5 .
doi: 10.1007/978-3-319-23018-4_5
D’Amico G, Morabito A, D’Amico M et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68:563–576. https://doi.org/10.1016/j.jhep.2017.10.020 .
doi: 10.1016/j.jhep.2017.10.020
pubmed: 29111320
de Franchis R. Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–752. https://doi.org/10.1016/j.jhep.2015.05.022 .
doi: 10.1016/j.jhep.2015.05.022
pubmed: 26047908
de Franchis R, Bosch J, Garcia-Tsao G et al. BAVENO VII - RENEWING CONSENSUS IN PORTAL HYPERTENSION: report of the Baveno VII Consensus Workshop: personalized care in portal hypertension. J Hepatol. 2021. https://doi.org/10.1016/j.jhep.2021.12.022 .
doi: 10.1016/j.jhep.2021.12.022
pubmed: 35120736
Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. American association for the study of liver diseases. Liver biopsy. Hepatology. 2009;49:1017–1044. https://doi.org/10.1002/hep.22742 .
doi: 10.1002/hep.22742
pubmed: 19243014
Zhou YJ, Gao F, Liu WY et al. Screening for compensated advanced chronic liver disease using refined Baveno VI elastography cutoffs in Asian patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2021;54:470–480. https://doi.org/10.1111/apt.16487 .
doi: 10.1111/apt.16487
pubmed: 34152626
Papatheodoridi M, Hiriart JB, Lupsor-Platon M et al. Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease. J Hepatol. 2021;74:1109–1116. https://doi.org/10.1016/j.jhep.2020.11.050 .
doi: 10.1016/j.jhep.2020.11.050
pubmed: 33307138
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. https://doi.org/10.1002/hep.28431 .
doi: 10.1002/hep.28431
pubmed: 26707365
Shalimar, Elhence A, Bansal B, et al. Prevalence of non-alcoholic fatty liver disease in India: A systematic review and meta-analysis. Journal of Clinical and Experimental Hepatology. Published online November 25, 2021. https://doi.org/10.1016/j.jceh.2021.11.010
Elhence A, Shalimar. Treatment of non-alcoholic fatty liver disease—current perspectives. Indian J Gastroenterol. 2020;39:22–31. https://doi.org/10.1007/s12664-020-01021-2 .
doi: 10.1007/s12664-020-01021-2
pubmed: 32152902
Wong VWS, Irles M, Wong GLH et al. Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease. Gut. 2019;68:2057–2064. https://doi.org/10.1136/gutjnl-2018-317334 .
doi: 10.1136/gutjnl-2018-317334
pubmed: 30658997
Anand A, Elhence A, Vaishnav M et al. FibroScan-aspartate aminotransferase score in an Asian cohort of non-alcoholic fatty liver disease and its utility in predicting histological resolution with bariatric surgery. J Gastroenterol Hepatol. 2021;36:1309–1316. https://doi.org/10.1111/jgh.15358 .
doi: 10.1111/jgh.15358
pubmed: 33232525
Brunt EM, Kleiner DE, Wilson LA, Belt P, Neuschwander-Tetri BA. NASH Clinical Research Network (CRN). Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatology. 2011;53:810–820. https://doi.org/10.1002/hep.24127 .
doi: 10.1002/hep.24127
pubmed: 21319198
Kleiner DE, Brunt EM, Van Natta M et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–1321. https://doi.org/10.1002/hep.20701 .
doi: 10.1002/hep.20701
pubmed: 15915461
Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156:1264-1281.e4. https://doi.org/10.1053/j.gastro.2018.12.036 .
doi: 10.1053/j.gastro.2018.12.036
pubmed: 30660725
Abraldes JG, Bureau C, Stefanescu H et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The “Anticipate” study. Hepatology. 2016;64:2173–2184. https://doi.org/10.1002/hep.28824 .
doi: 10.1002/hep.28824
pubmed: 27639071
Kumar R, Rastogi A, Sharma MK et al. Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease: diagnostic performance and clinicopathological correlation. Dig Dis Sci. 2013;58:265–274. https://doi.org/10.1007/s10620-012-2306-1 .
doi: 10.1007/s10620-012-2306-1
pubmed: 22790906
Eddowes PJ, Sasso M, Allison M et al. Accuracy of fibroscan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156:1717–1730. https://doi.org/10.1053/j.gastro.2019.01.042 .
doi: 10.1053/j.gastro.2019.01.042
pubmed: 30689971
Siddiqui MS, Vuppalanchi R, Van Natta ML et al. Vibration-controlled transient elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2019;17:156-163.e2. https://doi.org/10.1016/j.cgh.2018.04.043 .
doi: 10.1016/j.cgh.2018.04.043
pubmed: 29705261
Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. Published online May 17, 2021:gutjnl-2021–324243. https://doi.org/10.1136/gutjnl-2021-324243
Lee SS. Radiologic evaluation of nonalcoholic fatty liver disease. WJG. 2014;20:7392. https://doi.org/10.3748/wjg.v20.i23.7392 .
doi: 10.3748/wjg.v20.i23.7392
pubmed: 24966609
pmcid: 4064084
Ratziu V, Charlotte F, Heurtier A et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–1906. https://doi.org/10.1053/j.gastro.2005.03.084 .
doi: 10.1053/j.gastro.2005.03.084
pubmed: 15940625
Newsome PN, Sasso M, Deeks JJ et al. FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study. Lancet Gastroenterol Hepatol. 2020;5:362–373. https://doi.org/10.1016/S2468-1253(19)30383-8 .
doi: 10.1016/S2468-1253(19)30383-8
pubmed: 32027858
pmcid: 7066580
Selvaraj EA, Mózes FE, Jayaswal ANA et al. Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis. J Hepatol. 2021;75:770–785. https://doi.org/10.1016/j.jhep.2021.04.044 .
doi: 10.1016/j.jhep.2021.04.044
pubmed: 33991635
Imajo K, Honda Y, Kobayashi T, et al. Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. Published online December 17, 2020:S1542–3565(20)31673–6. https://doi.org/10.1016/j.cgh.2020.12.016