EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Berzigotti, Annalisa; Tsochatzis, Emmanuel; Boursier, Jérôme; Castéra, Laurent; Cazzagon, Nora; Friedrich‐Rust, Mireen; Petta, Salvatore; Thiele, Maja

doi:10.1016/j.jhep.2021.05.025

Cited by 1,013 publications

(789 citation statements)

References 306 publications

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“…However, so far, serum markers and Doppler ultrasound have shown limited diagnostic accuracy for portal hypertension and are not recommended by the current guidelines. 3,29 In the present study, we investigated eight serum-based non-invasive models, including AAR, APRI, CSPH risk score, FIB-4, Fibrosis Index, GPR, King's score, and Lok score, [16][17][18][19][20][21][22][23] and three imaging-based parameters, including liver stiffness, portal vein diameter and portal vein velocity. However, all of the above parameters showed poor diagnostic performance for identifying CSPH.…”

Section: Discussionmentioning

confidence: 99%

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Liu¹,

Tang²,

Örmeci³

et al. 2021

Journal of Clinical and Translational Hepatology

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Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis. Methods: In this international multicenter, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and noncontrast-enhanced MRI were prospectively recruited from five university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017. After segmentation of the liver on fat-suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity. Results: A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36 (p<0.0001) and 0.55 (p<0.01) for the training and validation cohorts, respectively. The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension (CSPH) was 0.81 and 0.9 in the training and validation cohorts, respectively. The intraclass correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841, respectively.

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Section: Discussionmentioning

confidence: 99%

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Liu¹,

Tang²,

Örmeci³

et al. 2021

Journal of Clinical and Translational Hepatology

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“…Third, we estimated liver fibrosis with FIB-4, which has not been validated against the gold standard of liver biopsy for alcohol-related liver disease [35]. Despite that few authors have expressed concerns about the accuracy of FIB-4 [36], the European Association for the Study of the Liver has recently published an updated version of their guideline for the non-invasive diagnosis of a liver injury and recommends the use of FIB-4 as a first-line method for detecting patients with high probability of presenting significant liver disease [37]. The present study adds to the literature that categorizes FIB-4 as a reliable tool for estimating liver fibrosis in patients in whom the performance of a liver biopsy is unlikely [38].…”

Section: Discussionmentioning

confidence: 99%

Markers of Monocyte Activation, Inflammation, and Microbial Translocation Are Associated with Liver Fibrosis in Alcohol Use Disorder

Fuster

Garcia-Calvo

Farré

et al. 2021

JCM

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Background: The association between markers of inflammation (interleukin (IL)-6 and IL-10), monocyte activation (sCD163 and sCD14), and microbial translocation (lipopolysaccharide (LPS) and LPS binding protein) and liver fibrosis in patients with alcohol use disorder (AUD) and no overt liver disease is not well established. Methods: We studied patients admitted for treatment of AUD at two hospitals in Barcelona. Advanced liver fibrosis (ALF) was defined as FIB-4 > 3.25. Results: A total of 353 participants (76.3% male) were included and 94 (26.5%) had ALF. In adjusted correlation analyses, sCD163, sCD14, IL-6, IL-10, and LPS binding protein levels directly correlated with FIB-4 values (adjusted correlation coefficients 0.214, 0.452, 0.317, 0.204, and 0.171, respectively). However, LPS levels were inversely associated with FIB-4 (−0.283). All plasma marker levels in the highest quartile, except LPS, were associated with ALF (sCD163, sCD14, IL-6, IL-10, and LPS binding protein: adjusted odds ratio (aOR) 11.49 (95% confidence interval 6.42–20.56), 1.87 (1.11–3.16), 2.99 (1.79–5.01), 1.84 (1.11–3.16), and 2.13 (1.30–3.50), respectively). Conversely, LPS levels in the lowest quartile were associated with ALF (aOR 2.58 (1.48–4.58), p < 0.01). Conclusion: In AUD patients, plasma levels of the markers of inflammation, monocyte activation, and microbial translocation are associated with ALF.

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“…Just recently, the EASL updated their "Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis", emphasizing the high predictive value and clinical relevance of simple non-invasive tests (NIT) such as the FIB-4 score (calculated on the basis of age, AST/ALT levels and platelet count [1]) to rule out advanced fibrosis and stratify the risk of liver-related outcomes in patients with non-alcoholic fatty liver disease (NAFLD) [2].…”

Section: Letter To the Editormentioning

confidence: 99%

“…Patients with other liver diseases (including liver cirrhosis and other liver diseases than NAFLD) or cancer diagnoses 12 months prior to the index date (initial ambulant NAFLD diagnosis) were excluded. NAFLD patients were stratified into a low risk (FIB-4 <1.30, n=17,967) and an intermediate-high risk group (FIB-4 ≥1.30, n=12,032), based on the EASL recommendation on NITs in patients observed in primary care or outside the liver clinic [2]. Basic characteristics of study patients are displayed in supplementary table 1.…”

Section: Letter To the Editormentioning

confidence: 99%

An elevated FIB-4 score predicts liver cancer development: A longitudinal analysis from 29,999 patients with NAFLD

Loosen

Kostev²,

Keitel

et al. 2022

Journal of Hepatology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Cited by 1,013 publications

References 306 publications

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study

Markers of Monocyte Activation, Inflammation, and Microbial Translocation Are Associated with Liver Fibrosis in Alcohol Use Disorder

An elevated FIB-4 score predicts liver cancer development: A longitudinal analysis from 29,999 patients with NAFLD

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