Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta‐analysis

Xiao, Guangqin; Zhu, Sixian; Xiao, Xiao; Yan, Lü-Nan; Yang, Jiayin; Wu, Gang

doi:10.1002/hep.29302

Cited by 721 publications

(693 citation statements)

References 35 publications

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“…However, VCTE requires a specialized device, and cannot properly assess hepatic fibrosis in patients with ascites and obesity . Whereas two‐dimensional shear wave elastography (2D‐SWE) is a form of elastography, and is a useful non‐invasive method for the diagnosis of hepatic fibrosis . SWE can be performed with a regular ultrasound examination.…”

Section: Introductionmentioning

confidence: 99%

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Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

Hepatology Research

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Aim Advanced hepatic fibrosis is seen in individuals with potential hepatocellular carcinoma and cardiovascular disease. Hepatic fibrosis can be assessed using a combination of the FIB‐4 index and imaging modalities, including shear wave elastography. We aimed to investigate the prevalence of advanced fibrosis in the general population and the profiles associated with advanced fibrosis using a data‐mining analysis. Methods We enrolled 1155 health checkup examinees (median age 53 years, 685 women, 470 male). Advanced fibrosis was defined by FIB‐4 index ≥1.3 and liver stiffness ≥8.07 kPa using shear wave elastography. Participants were classified as normal‐mild fibrosis (n = 1035) or advanced fibrosis (n = 120). Factors associated with advanced fibrosis were analyzed by logistic regression and decision‐tree analyses. Results Advanced fibrosis was observed in 10.4% of participants (120/1155). In the logistic regression analysis, independent factors for advanced fibrosis were age (≥75 years; OR 2.12, 95% CI 1.021–4.415; P = 0.0419) and the presence of metabolic syndrome (OR 2.51, 95% CI 1.416–4.462; P = 0.0017). The decision‐tree analysis showed two profiles associated with advanced fibrosis: profile 1 – individuals aged ≥65 years with metabolic syndrome and mild‐to‐moderate alcohol consumption (prevalence of advanced fibrosis 73.3%); and profile 2 – individuals without metabolic syndrome, aged ≥75 years, with no exercise habit (prevalence of advanced fibrosis 56.3%). Conclusions Advanced fibrosis was observed in 10.4% of health checkup examinees. Furthermore, we showed that aging, metabolic syndrome with mild‐to‐moderate alcohol consumption, and physical inactivity were associated with advanced fibrosis. Thus, prevention of metabolic syndrome and alcohol withdrawal, as well as exercise habits, might inhibit the progression of hepatic fibrosis.

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Section: Introductionmentioning

confidence: 99%

“…Furthermore, liver stiffness, as measured by SWE, is less affected by ascites and subcutaneous fat than VCTE . Recently, a meta‐analysis showed that SWE has higher diagnostic accuracy for staging fibrosis compared with VCTE …”

Section: Introductionmentioning

confidence: 99%

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

Hepatology Research

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“…9,10 TE is widely used because of its reproducibility and excellent interand intraobserver agreement, and it has been validated in enormous numbers of studies, which showed a very good correlation to histological assessment by liver biopsy. [15][16][17][18][19] However, the data regarding diagnostic performances of FIB-4 and APRI score compared with TE are limited. 8 Another currently available noninvasive method is the serum biomarkers of liver fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores for hepatic fibrosis assessment compared with transient elastography in chronic hepatitis C patients

et al. 2019

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Background and Aim Fibrotic stage (FS) assessment is essential in chronic hepatitis C treatment cascade. Liver stiffness measurement (LSM) using transient elastography (TE) is reliable and correlated with liver biopsy. However, TE may not be widely available. This study aimed to evaluate the diagnostic performances of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis 4 (FIB‐4) scores compared with TE. Methods We conducted a multicenter, cross‐sectional study, including all chronic hepatitis C virus (HCV) monoinfection patients with successful and reliable LSM, at 10 centers in Thailand from 2012 to 2017. Characteristics and laboratory data within 3 months of TE were retrospectively reviewed. Using TE as a reference standard, the diagnostic performances of APRI and FIB‐4 were evaluated. TE cut‐off levels of 7.1 and 12.5 kPa represented significant fibrosis (SF) and cirrhosis, respectively. Results The distribution of FS by TE in 2000 eligible patients was as follows: no SF 28.3%, SF 31.4%, and cirrhosis 40.3%. APRI ≥ 1 provided 70.1% sensitivity and 80.6% specificity, with an area under the receiver operator characteristics curve (AUROC) of 0.834 for cirrhosis. The specificity increased to 96.3% when using a cut‐off level of APRI ≥ 2. FIB‐4 ≥ 1.45 provided a sensitivity, specificity, and AUROC of 52.4%, 91.0%, and 0.829 for cirrhosis, respectively. For SF, APRI performed better than FIB‐4, with an AUROC of 0.84 versus 0.80 (P < 0.001). APRI score < 0.5 and FIB‐4 score > 1.45 yielded sensitivities of 82.3% and 74.4% and specificities of 65.4% and 69.8%, respectively. Conclusions APRI and FIB‐4 scores had good diagnostic performances for FS assessment compared with TE, especially for cirrhosis. APRI may be used as the noninvasive assessment in resource‐limited settings for HCV patients’ management.

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“…We have also shown that the sensitivity of serum ATX was high at all stages of fibrosis and was highest for the diagnosis of ≥stage 2 and ≥stage 3 in both men and women (Table ). There have been many reports regarding methods for the diagnosis of advanced fibrosis (≥stage 3) . However, Hagström et al .…”

Section: Discussionmentioning

confidence: 99%

Autotaxin is a valuable biomarker for the prediction of liver fibrosis in patients with non‐alcoholic fatty liver disease

Honda

Imajo

Kobayashi

et al. 2019

Hepatology Research

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Aim We investigated the characteristics of serum autotaxin (ATX) and its diagnostic performance for liver fibrosis in a large cohort of patients with non‐alcoholic fatty liver disease (NAFLD). Methods We compared the usefulness of ATX and other fibrosis markers in 307 biopsy‐confirmed NAFLD patients. In addition, in 145 participants with NAFLD, we compared the diagnostic performance of ATX with that of non‐invasive imaging methods (vibration‐controlled transient elastography and magnetic resonance elastography [MRE]). Results Serum ATX concentration was significantly correlated with fibrosis stage in male and female NAFLD patients. In male patients, the area under the receiver operating characteristic (AUROC) curve values of ATX for the diagnosis of ≥stage 1, ≥stage 2, ≥stage 3, and ≥stage 4 fibrosis were 0.65, 0.75, 0.81, and 0.95, respectively. In female NAFLD participants, the AUROC values were all >0.81. The sensitivity of ATX was highest for the diagnosis of ≥stage 2 and ≥stage 3 fibrosis in both men and women with NAFLD. In the comparison between ATX and non‐invasive imaging methods, the AUROC for MRE was the highest at every stage of fibrosis. Conclusions Serum ATX concentration is significantly correlated with fibrosis stage in NAFLD patients. The diagnostic accuracy of ATX for liver fibrosis is lower than that of MRE, but the sensitivities of ATX for the diagnosis of ≥stage 2 and ≥stage 3 were highest. We conclude that ATX is useful for the selection of patients requiring further evaluation for liver fibrosis.

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Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta‐analysis

Abstract: MRE and SWE may have the highest diagnostic accuracy for staging fibrosis in NAFLD patients. Among the four noninvasive simple indexes, NFS and FIB-4 probably offer the best diagnostic performance for detecting AF. (Hepatology 2017;66:1486-1501).

Cited by 721 publications

References 35 publications

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores for hepatic fibrosis assessment compared with transient elastography in chronic hepatitis C patients

Autotaxin is a valuable biomarker for the prediction of liver fibrosis in patients with non‐alcoholic fatty liver disease

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