Diagnostic accuracy and prognostic significance of noninvasive fibrosis
‘Diagnostic accuracy and prognostic significance of non-invasive fibrosis tests in NAFLD’ Journal Club 11. 12. 2017 Dr. ssa Federica Calvo Prof. Elisabetta Bugianesi
Worldwide prevalence of NAFLD Younossi & Bugianesi Nat Gastro Rev 2017 in press
Global NAFLD/NASH epidemic Diehl and Day. NEJM 2017
“The need for NAFLD screening in the community has been questioned given the high direct and indirect costs of testing, the low predictive value of non-invasive tests, the risks of liver biopsy and the lack of effective treatments “ “However, the progressive form of NAFLD (i. e. NASH), particularly when associated with advanced fibrosis, should be identified in patients at risk (age > 50 years, type 2 diabetes mellitus (T 2 DM) or Met. S), because of its prognostic implications”
Fibrosis, not NASH, predicts survival
Non-invasive markers in NAFLD: what we need?
EASL-EASD-EASO CPG for the management of non-alcoholic fatty liver diasease, 2016
Aims • Evaluate and directly compare the accuracy of eight blood tests and Fibro. Scan for the non-invasive diagnosis of liver fibrosis in a large population of NALFD patients and develop fibrosis classifications that allow a precise estimation of the histological fibrosis stage, without the need for liver biopsy (Cross-sectional study) • Validate the clinical relevance of fibrosis classifications by evaluating their prognostic accuracy (Longitudinal study).
Cross-sectional study Biopsy-proven included Biopsy-proven. NAFLD NALFDwere included from to 2014 at Angers and 2004 to 2014 at Angers and Bordeaux. University. Hospitals Hositals
Blood fibrosis tests q AST/platelet ratio index (APRI) § AST (IU/L)/ (ULN) /platelet count (x 109/L) x 100; Score > 1 associated with cirrhosis q FIB-4 score § age x AST (IU/L)/platelet count (x 109/L) x √ ALT (IU/L); Score < 1. 3 to exclude advanced fibrosis; Score > 3. 25 to diagnose advanced fibrosis q BARD score § AST/ALT ratio ≥ 0. 8 = 2 points; BMI ≥ 28 = 1 point; diabetes = 1 point. Range: from 0 to 4 points. q NAFLD Fibrosis Score (NFS) § -1. 675 + 0. 037 x Age (years) + 0. 094 x BMI (kg/m 2) + 1. 13 x IFG/diabetes (yes = 1, no = 0) + 0. 99 x AST/ALT ratio - 0. 013 x platelet (x 109/l) - 0. 66 x Albumin (g/dl). § Score < -1. 455 to exclude advanced fibrosis; Score > 0. 676 to diagnose advanced fibrosis q Commercial Panels including : Fibrotest, Fibro. Meter. NAFLD, Fibro. Meter V 2 G, Hepascore
Comparison of the diagnostic accuracy of non-invasive fibrosis tests
Comparison of the diagnostic accuracy of non-invasive fibrosis tests
Fibrosis Classifications -Fibrosis classifications of Fibro. Scan and Fibro. Meter V 2 G: estimation of the pathological fibrosis stage from the fibrosis tests results (diagnostic accuracy, respectively 80. 8% vs 77. 4%, p=0. 190). -LSM and FM V 2 G had the highest Obuchowsky index (ability of fibrosis tests to discriminate individual fibrosis stage).
Longitudinal study: outcome prediction From January 2005 to December 2009 360 NAFLD patients with blood sampling and LSM at baseline followed for a median period of 6. 4 yrs 83 pts died (causes of death: 20% liver-related complications, CVD 23%, malignacy 34%)
Elastography and Outcome Prediction
Fibro. Meter. V 2 G and Outcome Prediction
Conclusions • Fibroscan and Fibro. Meter. V 2 G were the two most accurate tests fot the non invasive diagnosis of liver fibrosis in NAFLD. • The fibrosis classifications are very relevant for clinical practice because, in addition to accurately estimate the liver fibrosis stage, they can be categorise patients into subgroups with significantly different prognosis, without the need for any liver biopsy.
Non-invasive markers in NAFLD: what we need?
5 year programme 47 EU Partners Academic and Industry 34 milion Euro Start: Nov 2017
- Slides: 22
