Noninvasive Tests Used in Risk Stratification of Patients with Nonalcoholic Fatty Liver Disease

Henry, Linda; Eberly, Katherine; Shah, Dipam; Kumar, Anuj; Younossi, Zobair M.

doi:10.1016/j.cld.2023.01.022

Cited by 7 publications

(4 citation statements)

References 115 publications

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“…Examinations were carried out by a trained operator. The CAP is a validated noninvasive tool for the evaluation of HS [ 18 ]. To consider the VCTE determinations reliable, the evaluations had to include at least 10 valid measurements, with a success rate ≥60% and an interquartile range (IQR) <30% of the median liver stiffness [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Hepatic Steatosis and Weight Gain During the Coronavirus Disease 2019 Pandemic Among People With Human Immunodeficiency Virus: Impact of Therapy With Tenofovir Alafenamide

Santos,

Corma-Gómez,

Martin-Carmona

et al. 2023

Open Forum Infectious Diseases

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Background Lockdown due to the coronavirus disease 2019 (COVID-19) pandemic led to increases in weight in part of the population. Weight gain leads to hepatic steatosis (HS). Antiretroviral treatment could also influence HS in people with human immunodeficiency virus (PWH). The impact of lockdown on HS in PWH is unknown. The aim of this study was to analyze the changes in HS, as measured by the controlled attenuation parameter (CAP), during the COVID-19 pandemic in PWH. Methods This was a cohort study that included PWH who attended a tertiary care center in southern Spain from January 2018 to December 2021. The CAP was evaluated by transient elastography. Only those who had a valid CAP before and after March 2020 were included. HS was defined as CAP ≥248 dB/m. Results Six hundred eighty PWH were attended and 488 (71.8%) were included. Two hundred and fourteen (43.9%) had HS at baseline and 239 (49%) at the end of the follow-up (P = .036). The median change in CAP among PWH taking tenofovir alafenamide (TAF) was 8.5 (interquartile range [IQR], −24 to 46.3) dB/m versus −4 (IQR, −35 to 27) dB/m among PWH receiving TAF-free regimens (P = .003). After multivariate analysis, adjusted by sex and age, weight gain (adjusted odds ratio [AOR], 1.09 [95% confidence interval {CI}, 1.05–1.14]; P < .001), TAF therapy (AOR, 1.59 [95% CI, 1.07–2.35]; P = .021), plasma triglycerides (AOR, 1.01 [95% CI, 1–1.01]; P < .001), and fasting blood glucose (AOR, 1.01 [95% CI, 1–1.02]; P = .027) were associated with HS at the end of follow-up. Conclusions The frequency of HS increased during the COVID-19 pandemic among PWH. TAF is associated with HS development, regardless of metabolic factors.

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Section: Methodsmentioning

confidence: 99%

Hepatic Steatosis and Weight Gain During the Coronavirus Disease 2019 Pandemic Among People With Human Immunodeficiency Virus: Impact of Therapy With Tenofovir Alafenamide

Santos,

Corma-Gómez,

Martin-Carmona

et al. 2023

Open Forum Infectious Diseases

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“…Alongside with increasingly advocated personalized and precision medicine approaches, risk stratification has become more and more investigated in the hepatological arena aimed at identifying those primary care patients needing hepatological consultation; as well as those who may benefit most of personalized follow-up schedules and more intensive treatment approaches given that they are prone to the highest risk of severe complications [11,15]. Additionally, the identification of homogeneous patient populations is of key importance in correctly describing subsets of enrollees in randomized clinical trials (RCTs) of novel drug treatments therefore possibly decreasing the presently disappointing results of RCTs [16].…”

Section: Rationale and Aimmentioning

confidence: 99%

“…An improved understanding of NAFLD factors and cofactors that affect disease expressivity and outcomes, in its turn, may translate into the benefits of designing more personalized and precision medicine approaches to offer maximally effective management strategies to those NAFLD individuals with the highest risk of poor sequels [16,22,23].…”

Section: The Pathogenic and Clinical Heterogeneity Of Nafld Lays The ...mentioning

confidence: 99%

Principles of risk stratification in nonalcoholic fatty liver disease. A narrative review emphasizing non-invasive strategies

Lonardo

2023

Explor Dig Dis

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Nonalcoholic fatty liver disease (NAFLD) is an umbrella definition that describes the ectopic deposition of fat within the liver that occurs in the absence of inciting factors other than the metabolic syndrome and its individual features. NAFLD has a multi-factorial pathogenesis which determines heterogeneous clinical phenotypes and variable natural course spanning from liver-related (steatohepatitis, fibrosis, cirrhosis, hepatocellular carcinoma) to extrahepatic outcomes (cardio-metabolic and cancer). This narrative review article leverages the key aspects of disease natural history as the background information to discuss studies that may inform strategies to risk-stratify NAFLD patients. Evaluation of hepatic fibrosis with non-invasive tools, including blood-based biomarkers and imaging-based elastometry techniques, seemingly retains the core information useful to predict the heterogeneous outcomes listed above. Additionally, genetic testing and metabolomic profiles may also be utilized to this end. In conclusion, a comprehensive understanding of the variable hepatic, cardio-metabolic and cancer outcomes of NAFLD may enable physicians and researchers to risk-stratify and accurately identify the multilayered prognosis of NAFLD individuals while also defining homogeneous patient subsets to enroll in clinical trials.

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“…Therefore, programs that combine raising awareness in the primary care setting with algorithms using validated NITs to identify "high-risk" NAFLD patients have become increasingly important. [20][21][22][23][24][25][26][27] These algorithms should combine clinical data with a combination of different types of NITs to optimize their performance. Once established, the cost-effectiveness of these pathways to identify high-risk NAFLD patients should be considered.…”

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confidence: 99%

How to Identify Advanced Nonalcoholic Fatty Liver Disease in the Primary Care Setting

2023

Self Cite

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Nonalcoholic fatty liver disease (NAFLD) affects 30 to 40% of the population globally and is increasingly considered the most common liver disease. Patients with type 2 diabetes, obesity, and cardiovascular diseases are at especially increased risk for NAFLD. Although most patients with NAFLD do not have progressive liver disease, some patients progress to cirrhosis, liver cancer, and liver mortality. Given the sheer number of patients with NAFLD, the burden of disease is enormous. Despite this large and increasing burden, identification of NAFLD patients at risk for progressive liver disease in the primary care and diabetology practice settings remains highly suboptimal. In this review, our aim is to summarize a stepwise approach to risk stratify patients with NAFLD which should help practitioners in their management of patients with NAFLD.

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Noninvasive Tests Used in Risk Stratification of Patients with Nonalcoholic Fatty Liver Disease

Cited by 7 publications

References 115 publications

Hepatic Steatosis and Weight Gain During the Coronavirus Disease 2019 Pandemic Among People With Human Immunodeficiency Virus: Impact of Therapy With Tenofovir Alafenamide

Hepatic Steatosis and Weight Gain During the Coronavirus Disease 2019 Pandemic Among People With Human Immunodeficiency Virus: Impact of Therapy With Tenofovir Alafenamide

Principles of risk stratification in nonalcoholic fatty liver disease. A narrative review emphasizing non-invasive strategies

How to Identify Advanced Nonalcoholic Fatty Liver Disease in the Primary Care Setting

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