Low Utility of Noninvasive Fibrosis Scores in Young Adults with Nonalcoholic Fatty Liver Disease

Doycheva, Iliana; Shaker, Mina; Allende, Daniela S.; López, Rocío; Watt, Kymberly D.; Alkhouri, Naim

doi:10.1038/ajg.2016.596

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…In this context, NAFLD biomarkers can target domains that can be defined as the following: (1) diagnostic markers, reflecting current stage of fibrosis; (2) prognostic markers, stratifying individuals by fibrosis progression risk, discriminating fast versus slow progressors, and/or predicting long‐term outcomes and hard endpoints; and (3) monitoring markers that may be used to track disease progression or treatment response. Such biomarkers should be at one of four qualification levels: (1) exploration (early‐phase experimental biomarkers); (2) demonstration (“probable valid” biomarkers); (3) characterization (“known valid” biomarkers); and (4) surrogacy (registerable “surrogate endpoint”) . Although there has been some progress in biomarker development for detection of AF, existing biomarkers are generally at the first two qualification levels and need further independent validation.…”

Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

“…It is also important to note that these scores may not be helpful in the younger age group and perform poorly with relatively low AUROC. In this context, the exact cut‐off threshold and validity of these noninvasive tests in the clinical setting require further external validation before their full clinical use can be recommended …”

Section: Indirect Markers and “Simple Panels”mentioning

confidence: 99%

“…(2) demonstration ("probable valid" biomarkers); (3) characterization ("known valid" biomarkers); and (4) surrogacy (registerable "surrogate endpoint"). (69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82) Although there has been some progress in biomarker development for detection of AF, existing biomarkers are generally at the first two qualification levels and need further independent validation.…”

Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

“…In this context, the exact cut-off threshold and validity of these noninvasive tests in the clinical setting require further external validation before their full clinical use can be recommended. (75)(76)(77)(78)(79)…”

Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

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Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

et al. 2018

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Nonalcoholic fatty liver disease (NAFLD) is a spectrum comprised of isolated steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and do not carry a significant risk for liver-related adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25%. In Asia, a gradient of high to low prevalence rates is noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition of NASH as an important liver disease, the diagnosis of NASH still requires a liver biopsy that is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, this method suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathological features. A number of noninvasive modalities to diagnose NASH and stage liver fibrosis are being developed. These modalities include predictive models (NAFLD fibrosis score) and serum biomarkers such as enhanced liver fibrosis (ELF). Other tests are based on radiological techniques, such as transient elastography (TE) or magnetic resonance elastography (MRE), which are used to estimate liver stiffness as a potential surrogate of hepatic fibrosis. Although a dynamic field of research, most of these diagnostic modalities have area under the curve ranging between 0.76 and 0.90%, with MRE having the best predictive performance. In summary, developing safe and easily accessible noninvasive modalities to accurately diagnose and monitor NASH and associated fibrosis is of utmost importance in clinical practice and clinical research. These tests are not only important to risk stratify subjects at the greatest risk for progressive liver disease, but also to serve as appropriate surrogate endpoints for therapeutic clinical trials of NASH. (Hepatology 2018;68:349-360).

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Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

Section: Indirect Markers and “Simple Panels”mentioning

confidence: 99%

Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

Section: Serum Fibrosis Markers In Nashmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

et al. 2018

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“…For this reason, in a recent study on 634 biopsy-proven NAFLD patients, new thresholds (FIB-4 > 2 and NFS > 0.12) were proposed, in order to lower the false positive rate maintaining the same specificity [81]. Similarly, in young adults (< 35 years) NFS and FIB-4 showed a poor diagnostic performance, with AUROCs of < 0.53 and, then, further investigations are needed to define an appropriate cutoff for this category [82]. In addition, it has to be pointed out that the use of these tests in a primary care referral setting, allows discriminating only patients with liver fibrosis > F3.…”

Section: Biochemical Tests For Evaluation Of Fibrosismentioning

confidence: 99%

The diagnostic conundrum in non-alcoholic fatty liver disease

Rosato

Masarone

Aglitti

et al. 2020

Exploration of Medicine

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Non-alcoholic fatty liver disease (NAFLD) has become the most common liver alteration worldwide. It encompasses a spectrum of disorders that range from simple steatosis to a progressive form, defined non-alcoholic steatohepatitis (NASH), that can lead to advanced fibrosis and eventually cirrhosis and hepatocellular carcinoma. On liver histology, NASH is characterized by the concomitant presence of significant fat accumulation and inflammatory reaction with hepatocellular injury. Until now, liver biopsy is still required to differentiate simple steatosis from NASH and evaluate the degree of liver fibrosis. Unfortunately, this technique has well-known limitations, including invasiveness and expensiveness. Moreover, it may be biased by sampling error and intra- or inter-observed variability. Furthermore, due to the increasing prevalence of NAFLD worldwide, to program a systematic screening with liver biopsy is not imaginable. In recent years, different techniques were developed and validated with the aim of non-invasively identifying NASH and assess liver fibrosis degrees. The non-invasive tests range from simple blood-tests analyses to composite scores and complex imaging techniques. Nevertheless, even if they could represent cost-effective strategies for diagnosing NASH, advanced fibrosis and cirrhosis, their accuracy and consequent usefulness are to be discussed. With this aim, in this review the authors summarize the current state of non-invasive assessment of NAFLD. In particular, in addition to the well-established tests, the authors describe the future perspectives in this field, reporting the latest tests based on OMICS, gut-miocrobioma and micro-RNAs. Finally, the authors provide an accurate assessment of how these non-invasive tools perform in clinical practice depending on the clinical context, with the aim of giving the clinicians a useful tool to try to resolve the diagnostic conundrum of NAFLD.

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European paediatric non-alcoholic fatty liver disease registry (EU-PNAFLD): Design and rationale

Mann

Vreugdenhil

Socha

et al. 2018

Contemporary Clinical Trials

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Low Utility of Noninvasive Fibrosis Scores in Young Adults with Nonalcoholic Fatty Liver Disease

Cited by 5 publications

References 3 publications

Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

The diagnostic conundrum in non-alcoholic fatty liver disease

European paediatric non-alcoholic fatty liver disease registry (EU-PNAFLD): Design and rationale

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