Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes

Abstract

Background and Aims: We evaluated the diagnostic accuracy of simple, noninvasive tests (NITs) in NAFLD patients with type 2 diabetes (T2D). Methods and Results: This was an individual patient data meta-analysis of 1780 patients with biopsy-proven NAFLD and T2D. The index tests of interest were FIB-4, NAFLD Fibrosis Score (NFS), aspartate aminotransferase-to-platelet ratio index, liver stiffness measurement (LSM) by vibration-controlled transient elastography, and AGILE 3+. The target conditions were advanced fibrosis, NASH, and fibrotic NASH(NASH plus F2-F4 fibrosis). The diagnostic performance of noninvasive tests. individually or in sequential combination, was assessed by area under the receiver operating characteristic curve and by decision curve analysis. Comparison with 2278 NAFLD patients without T2D was also made. In NAFLD with T2D LSM and AGILE 3+ outperformed, both NFS and FIB-4 for advanced fibrosis (area under the receiver operating characteristic curve:LSM 0.82, AGILE 3+ 0.82, NFS 0.72, FIB-4 0.75, aspartate aminotransferase-to-platelet ratio index 0.68; p < 0.001 of LSM-based versus simple serum tests), with an uncertainty area of 12%–20%. The combination of serum-based with LSM-based tests for advanced fibrosis led to a reduction of 40%–60% in necessary LSM tests. Decision curve analysis showed that all scores had a modest net benefit for ruling out advanced fibrosis at the risk threshold of 5%–10% of missing advanced fibrosis. LSM and AGILE 3+ outperformed both NFS and FIB-4 for fibrotic NASH (area under the receiver operating characteristic curve:LSM 0.79, AGILE 3+ 0.77, NFS 0.71, FIB-4 0.71; p < 0.001 of LSM-based versus simple serum tests). All noninvasive scores were suboptimal for diagnosing NASH. Conclusions: LSM and AGILE 3+ individually or in low availability settings in sequential combination after FIB-4 or NFS have a similar good diagnostic accuracy for advanced fibrosis and an acceptable diagnostic accuracy for fibrotic NASH in NAFLD patients with T2D.

Risk of liver-related events in metabolic dysfunction–associated steatohepatitis (MASH) patients with fibrosis: A comparative analysis of various risk stratification criteria

“…These LSM values have also been validated as capable of stratifying the risk of developing LRE 26 . Moreover, recent studies suggest using AGILE 3+ as an LSM-based noninvasive tool for identifying patients at high risk of advanced fibrosis and of LRE, because of its yielding a slight improvement with respect to LSM 25,26,31 …”

Diagnostic accuracy of AGILE 3+ score for advanced fibrosis in patients with NAFLD: A systematic review and meta-analysis

“…The study by Sanyal et al 10 included data from 4 subgroups separately. For the study by Yilmaz et al 17 and Pennisi et al, 18 we obtained data for patients who underwent liver biopsy from the corresponding authors. We evaluated the presence of potential bias in the patient selection, blinding to the histological diagnosis, description of the reference standard, and inclusion of all patients in the analysis.…”

Performance of noninvasive seromarkers in predicting liver fibrosis among MAFLD patients with or without viral hepatitis

“…The of the best cut-off value of FIB-4 in different fibrotic stages in MAFLD patients with or without viral hepatitis. of liver fibrosis,28,31 and this, it should serve as an alternative reference in population-based studies.32 In conclusion, serum-based biomarkers, including APRI, FIB-4 and NFS, could predict liver disease severity in Taiwanese MAFLD patients. The predictive power was enhanced with the advent of progressive liver fibrosis.…”