Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Abstract

Heterogeneity in clinical presentation, histological severity, prognosis and therapeutic outcomes charac teristic of nonalcoholic fatty liver disease (NAFLD) necessitates the development of scientifically sound classification schemes to assist clinicians in stratifying patients into meaningful prognostic subgroups. The need for replacement of invasive liver biopsies as the standard method whereby NAFLD is diagnosed, graded and staged with biomarkers of histological severity injury led to the development of composite prognostic models as potentially viable surrogate alternatives. In the present article, we review existing scoring systems used to (1) confirm the presence of undiagnosed hepatosteatosis; (2) distinguish between simple steatosis and NASH; and (3) predict advanced hepatic fibrosis, with particular emphasis on the role of NAFLD as an independent cardiometabolic risk factor. In addition, the incorporation of functional genomic markers and application of emerging imaging technologies are discussed as a means to improve the diagnostic accuracy and predictive performance of promising composite models found to be most appropriate for widespread clinical adoption. Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries have entered the clinical domain as potentially viable alternatives. Lifestylebased intervention remains the cornerstone of treatment in patients with NAFLD. The widespread clinical adoption of composite diagnostic and predictive models could however prove useful in informing clinical and therapeutic decision making with the goal of adding value to patient care across the NAFLD spectrum.Lückhoff HK, Kruger FC, Kotze MJ. Composite prognostic models across the non-alcoholic fatty liver disease spectrum:

miR33a/miR33b* and miR122 as Possible Contributors to Hepatic Lipid Metabolism in Obese Women with Nonalcoholic Fatty Liver Disease

“…ROC analysis revealed that miR122 has the potential to distinguish NASH from SS, because it predicts hepatocellular ballooning or lobular inflammation with an AUROC of 0.76. Although this predictive value is not good enough for an ideal biomarker, the ability of miR122 to predict NASH is quite similar to that of other studies [52,53,54]. However, as these authors suggested, compared to single biomarkers, the stepwise combination of different biomarkers can further improve the accuracy of diagnosing NASH.…”

A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings

“…Using hemodynamic data acquired during the combined cardiac catheterization and liver biopsy procedures, Figures show no significant correlation between TFS and inferior vena caval pressure, pulmonary vascular resistance, or univentricular end‐diastolic pressure, respectively. We found no significant correlations between TFS or elastography measurements and APRi (AST to platelet ratio index) scores, individual ALT values, or AST/ALT ratios …”

“…We developed a noninvasive, composite index, comprised of hepatic ultrasound SWE measurements, MELD‐XI scores, and time post‐Fontan, which strongly correlated with TFS from liver biopsy. Noninvasive, composite indexes, some with highly complex best‐fit equations employing several mathematical transformations, have been previously developed for noninvasively predicting non‐Fontan related liver fibrosis, after recognizing that individual markers had poor discriminatory power and limited clinical use in stratifying patients into prognostic subgroups …”

“…In patients with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease, composite models comprised of laboratory values, patient characteristics, and hepatic elastography either by magnetic resonance or ultrasound, have been developed primarily to predict the presence of cirrhosis . However, to the best of our knowledge, there are only two post‐Fontan reports, with 10 patients each, that have compared liver biopsy findings with either magnetic resonance or ultrasound hepatic elastography .…”

“…Notwithstanding its limitations, secondary to sampling and intraobserver and interobserver variations, liver biopsy is the accepted gold standard for determining the degree of hepatic fibrosis, regardless the etiology; nevertheless, a noninvasive method that correlates with the degree of liver fibrosis would be a more practical clinical approach. Previous, large patient cohort studies report correlations between liver pathology and noninvasive methods, including composite models comprised of multiple patient variables, in those with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease . However, there are few reports comparing liver biopsy findings with noninvasive approaches in patients with Fontan associated liver disease (FALD); thus, there are no current, useful, clinic‐based, noninvasive methods that strongly correlate one with the other .…”