Predictors of advanced fibrosis in elderly patients with biopsy-confirmed nonalcoholic fatty liver disease: the GOASIA study

Abstract

Background: The Gut and Obesity in Asia (GOASIA) Workgroup was formed to study obesity and gastrointestinal diseases in the Asia Pacific region. We aimed to 1) compare the characteristics of elderly (i.e. age ≥ 60) vs. nonelderly patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD); 2) identify predictors of advanced fibrosis in elderly patients with NAFLD; and 3) assess the performance of non-invasive fibrosis scores in the prediction of advance fibrosis in the elderly population. Methods: We abstracted the data of 1008 patients with NAFLD from nine centers across eight countries. Characteristics of elderly and non-elderly patients with NAFLD were compared using 1:3 sex-matched analysis. Results: Of the 1008 patients, 175 were elderly [age 64 (62-67) years], who were matched with 525 non-elderly patients [46 (36-54) years]. Elderly patients were more likely to have advanced fibrosis (35.4% vs. 13.3%; p < 0.001). By multivariable analysis, factors associated with advanced fibrosis in elderly patients included female sex [odds ratio (OR) 3.21; 95% confidence interval (CI) 1.37-7.54] and hypertension (OR 3.68; 95%CI 1.11-12.23). The area under receiver-operating characteristics curve (95% CI) of aspartate aminotransferase-to-platelet ratio index, NAFLD fibrosis score and Fibrosis-4 index for predicting advanced fibrosis in elderly patients were 0.62 (0.52-0.72), 0.65 (0.55-0.75) and 0.64 (0.54-0.74) respectively. Conclusions: Elderly patients with NAFLD had a higher prevalence of advanced fibrosis than non-elderly patients. Female and hypertension were predicting factors for advanced fibrosis in the elderly. Non-invasive fibrosis scores had a lower specificity in elderly.

Diagnostic Accuracy of FIB-4 and FIB-5 Scores as Compared to Fibroscan for Assessment of Liver Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease

“…In our study, the advanced stage of fibrosis was associated with advanced age which is consistent with other previous studies [ 11 - 12 ]. A possible explanation is increased affiliation of risk factors like hypertension, diabetes mellitus type II, and/or obesity with age [ 13 ]. Also, according to “the free radical theory of aging”, the reactive oxygen species generated cannot be nullified due to impaired antioxidant defence system in aged people which elevates oxidative stress level thus causing alteration in cell growth and tumour suppressor gene [ 14 ].…”

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

“…A total of 1370 MAFLD patients (78.5%) exhibited a low cut-off index (COI) (<1.30), 357 (20.5%), exhibited an indeterminate COI (1.30–2.67), and 18 (1.0%) exhibited a high COI (>2.67) [ 92 ]. Among 5410 Japanese MAFLD patients who were diagnosed by health checkups, 87.4% exhibited low COI (<1.45), 12.1% exhibited an indeterminate COI (1.45–3.26), and 0.5% exhibited a high COI (>3.26) [ 93 ]. On data of 576 MAFLD with biopsy proven MAFLD from JSG-NAFLD, 336 (58.3%) exhibited low COI (<1.45), 31.4% exhibited an indeterminate COI (1.45–3.26), and 59 (10.2%) exhibited a high COI (>3.26) [ 16 ].…”

NAFLD in the Elderly

“…In a recent study, these cut-offs were tested and the low specificity confirmed in elderly Asian patients. 122 By using the new age-adjusted cut-offs proposed by McPherson, specificity was increased albeit at the cost of lower sensitivity. Therefore, more studies are necessary to understand how to employ fibrosis scoring systems while taking the patient’s age into account.…”

“…Initial studies assessing the utility of these scores focused primarily on middle-aged patients, did not include elderly patients or failed to determine the diagnostic cut-off values in this cohort of patients. [119][120][121][122] Because both NFS and FIB-4 take age into account, there is an inflation of the score in the elderly due to the inclusion of this parameter by itself. As a result, more patients are considered to be intermediate-risk in virtue of their age, which increases the false positive rate.…”