Meta‐analysis: Enhanced liver fibrosis test to identify hepatic fibrosis in chronic liver diseases

Hinkson, Alexander; Lally, Hannah; Gibson, Hannah; Jones, Rebecca; Rowe, Ian; Shinkins, Bethany; Parker, Richard

doi:10.1111/apt.17385

Cited by 12 publications

(7 citation statements)

References 105 publications

(238 reference statements)

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“…[4] Indeed, the initial cutoffs for ELF (< 7.7, 7.7-9.8, > 9.8) have been controversial. Despite inclusion in the AASLD guidelines, there is very limited data supporting the use of 7.7 cutoff; on the contrary, clinical evidence supports the use of 9.8 and 11.3 cutoffs, [5] as confirmed in the current study showing 0% of cases with ELF score <7.7. By using higher cutoffs (9.8 and 11.3), as shown in the third arm of the study, unnecessary referrals decrease by up to 20% without significantly increasing the false negative rate.…”

mentioning

confidence: 49%

Looking for the best algorithm in the diabetes population for advanced fibrosis detection: The best is the enemy of the good

Romero-Gómez,

Lara

2023

Hepatology

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mentioning

confidence: 49%

Looking for the best algorithm in the diabetes population for advanced fibrosis detection: The best is the enemy of the good

Romero-Gómez,

Lara

2023

Hepatology

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“…These AUC values are much higher than those for the FIB-4 (AUC 0.751) and APRI algorithms (AUC 0.737) for significant fibrosis [ 14 ] (see Additional File 1 ). The diagnostic accuracy of the ELF algorithm, which combines detection of hyaluronic acid, type III procollagen peptide (PIIINP), and tissue inhibitor of metalloproteinase-1 (TIMP1), was evaluated in a recent meta-analysis of studies including nearly 20,000 individuals with or at risk of developing a wide variety of viral and non-viral liver diseases [ 35 ]. The analysis reported an AUC of 0.811 for detecting fibrosis, 0.812 for advanced fibrosis, and 0.810 for advanced cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Validation of the novel GLAS algorithm as an aid in the detection of liver fibrosis and cirrhosis based on GP73, LG2m, age, and sex

Hemken,

Qin,

Sokoll

et al. 2023

Clin Proteom

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Background Diagnosis of liver disease at earlier stages can improve outcomes and reduce the risk of progression to malignancy. Liver biopsy is the gold standard for diagnosis of liver disease, but is invasive and sample acquisition errors are common. Serum biomarkers for liver function and fibrosis, combined with patient factors, may allow for noninvasive detection of liver disease. In this pilot study, we tested and validated the performance of an algorithm that combines GP73 and LG2m serum biomarkers with age and sex (GLAS) to differentiate between patients with liver disease and healthy individuals in two independent cohorts. Methods To develop the algorithm, prototype immunoassays were used to measure GP73 and LG2m in residual serum samples collected between 2003 and 2016 from patients with staged fibrosis and cirrhosis of viral or non-viral etiology (n = 260) and healthy subjects (n = 133). The performance of five predictive models using combinations of age, sex, GP73, and/or LG2m from the development cohort were tested. Residual samples from a separate cohort with liver disease (fibrosis, cirrhosis, or chronic liver disease; n = 395) and healthy subjects (n = 106) were used to validate the best performing model. Results GP73 and LG2m concentrations were higher in patients with liver disease than healthy controls and higher in those with cirrhosis than fibrosis in both the development and validation cohorts. The best performing model included both GP73 and LG2m plus age and sex (GLAS algorithm), which had an AUC of 0.92 (95% CI: 0.90–0.95), a sensitivity of 88.8%, and a specificity of 75.9%. In the validation cohort, the GLAS algorithm had an estimated an AUC of 0.93 (95% CI: 0.90–0.95), a sensitivity of 91.1%, and a specificity of 80.2%. In both cohorts, the GLAS algorithm had high predictive probability for distinguishing between patients with liver disease versus healthy controls. Conclusions GP73 and LG2m serum biomarkers, when combined with age and sex (GLAS algorithm), showed high sensitivity and specificity for detection of liver disease in two independent cohorts. The GLAS algorithm will need to be validated and refined in larger cohorts and tested in longitudinal studies for differentiating between stable versus advancing liver disease over time.

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“…The enhanced liver fibrosis score and FibroTest are patented blood-based biomarkers with higher specificity (80%–90%), but with higher cost and limited availability, especially in resource-constrained settings (120). It should be acknowledged that enhanced liver fibrosis is not as well validated in patients with ALD as other etiologies such as HCV and MASLD (124). Furthermore, platelets can be reduced by active alcohol use, which can affect the accuracy of FIB-4 as a noninvasive serological marker for fibrosis assessment in patients with ALD (1).…”

Section: Ald Disease Spectrummentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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Meta‐analysis: Enhanced liver fibrosis test to identify hepatic fibrosis in chronic liver diseases

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 12 publications

References 105 publications

Looking for the best algorithm in the diabetes population for advanced fibrosis detection: The best is the enemy of the good

Looking for the best algorithm in the diabetes population for advanced fibrosis detection: The best is the enemy of the good

Validation of the novel GLAS algorithm as an aid in the detection of liver fibrosis and cirrhosis based on GP73, LG2m, age, and sex

ACG Clinical Guideline: Alcohol-Associated Liver Disease

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