Serial combination of non‐invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with <scp>NAFLD</scp>

Petta, Salvatore; Wong, Vincent Wai‐Sun; Cammà, Calogero; Hiriart, Jean‐Baptiste; Wong, Grace Lai–Hung; Vergniol, Julien; Chan, Anthony W.H.; Marco, V. Di; Merrouche, Wassil; Marra, Fabio; Lebail, B.; Arena, Umberto; Craxı̀, Antonio; Lédinghen, Victor de

doi:10.1111/apt.14219

Cited by 150 publications

(140 citation statements)

References 32 publications

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“…This is also reflected by the diagnostic performance in detecting single fibrosis stages, in which LiMAx ® was superior (AUROCs for ≥F2: 0.8451 vs. 0.7584; ≥F3: 0.8409 vs. 0.8342; F4: 0.8902 vs. 0.8483) except for detecting the presence of fibrosis (≥F1: AUROC 0.8207 vs. 0.8267). In general, the prognostic values of TE in our study lay slightly below those described in the literature (AUROCs of 0.74-0.97), which might be explained by our more diversified patient cohort including all kinds and stages of CLD [5,18,22,25,26,47]. Furthermore, the high range of aminotransferases (14-1,253 U/L for AST and 9-1,527 U/L for ALT) and bilirubin levels (0.2-24.0 mg/dL) reflecting acute inflammation in CLD may overestimate the grade of fibrosis.…”

Section: Discussioncontrasting

confidence: 80%

“…The velocity of this shear wave is supposed to be directly proportional to the stiffness of the liver, which mainly depends on the amount of fibrotic material [5,37]. Although TE has shown good diagnostic accuracy in detecting significant fibrosis or cirrhosis in selected patients with viral-or autoimmune hepatitis, its performance in other etiologies such as NAFLD is still discussed contro- versially [15,18,22,23,25,26,[37][38][39]. Furthermore, anatomic conditions and presence of ascites reduce its feasibility in a significant number of patients in whom valuable results are not obtainable.…”

Section: Discussionmentioning

confidence: 99%

“…The correlation between enzymatic liver function measured by LiMAx ® and different stages of fibrosis was superior (Spearman's r = -0.68) when compared to validated [5,18,19,21,22,25,26,[44][45][46][47][48][49][50][51]. Transient elastography (TE) is probably the most validated method worldwide in the noninvasive assessment of liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Different diagnostic tools have been developed and partly implemented in clinical practice and international guidelines [14][15][16]. Serum biomarkers such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) score based on readily available laboratory parameters have been extensively examined to stage liver fibrosis [17][18][19][20][21]. In addition, liver stiffness determined by transient elastography (TE), a technique based on the measurement of the velocity of a shear wave that is induced to the liver by a mechanical impulse, is probably the most validated noninvasive method to assess the stage of liver fibrosis with reliable diagnostic accuracy for different etiologies of CLD [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

et al. 2018

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Aim: To assess the diagnostic accuracy of liver maximum capacity (LiMAx®) test compared to transient elastography (TE) and serum biomarkers for the noninvasive detection of different stages of liver fibrosis and cirrhosis. Patients and Methods: We retrospectively correlated LiMAx®, TE, aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) score with histological specimens in 102 patients with chronic liver disease (CLD) who underwent liver biopsy (either percutaneously or via mini-laparoscopy) at the University Clinic of Essen between 10/2016 and 12/2017. Results: Median LiMAx® values showed a tendency to decrease in accordance with increasing histological degree of fibrosis based on the Desmet scoring system (F0: 446.5 [381.0–592.5] µg/h/kg, F1: 405.0 [343.0–547.0] µg/h/kg, F2: 337.0 [250.0–394.0] µg/h/kg, F3: 281.0 [262.0–364.0] µg/h/kg, and F4: 181.5 [130.0–256.5] µg/h/kg. Furthermore, LiMAx® was superior to TE, FIB-4, AAR, and APRI in detecting different stages of fibrosis, while Spearman’s rank correlation test showed a statistically significant association of –0.68, 0.62, 0.61, 0.46, and 0.42, respectively. However, the combination of TE and LiMAx® had the highest diagnostic accuracy in detecting liver cirrhosis (sensitivity 88.9%, specificity 84.6%, Youden index 0.735). Conclusion: Enzymatic liver function measured by LiMAx® showed strong correlation with histology in patients with CLD irrespective of its underlying etiology and was superior to TE and serum biomarkers, possibly making it useful as a novel and noninvasive tool for the determination of hepatic disease severity.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

et al. 2018

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“…Staging of liver fibrosis can be undertaken with the use of biopsy or various non-invasive tests925 (table 4). Choice of test will depend on local availability.…”

Section: What Are the Next Investigations?mentioning

confidence: 99%

Tests for diagnosing and monitoring non-alcoholic fatty liver disease in adults

Byrne

Patel

Scorletti

et al. 2018

BMJ

133

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At a routine health check arranged by his company, a 52 year-old sedentary male computer programmer was found to have a serum alanine aminotransferase (ALT) concentration of 68 IU/L (normal 0-40 IU/L), and a triglyceride concentration of 1.9 mmol/L. His fasting plasma glucose levels were 5.8 mmol/L and other basic liver, renal and lipid blood tests were normal. He had an unremarkable medical history and took no regular medications, did not smoke and consumed <7 units of alcohol/week. Clinical examination was unremarkable. His body mass index was 29 kg/m 2 ; waist circumference 102 cm and blood pressure 134/88 mmHg.

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The role of noninvasive biomarkers in diagnosis and risk stratification in nonalcoholic fatty liver disease

Román

Siddiqui

2020

Endocrino Diabet & Metabol

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Nonalcoholic fatty liver disease (NAFLD) is characterized by the presence of ectopic fat deposition within the liver not attributable to alcohol or secondary causes of hepatic steatosis. 1 NAFLD, as the aetiology of chronic liver disease, has increased rapidly over the past three decades in the United States and is now the most common cause of chronic liver disease accounting for nearly 75% of all chronic liver diseases and affecting nearly one in three individuals. 2,3 NAFLD is commonly associated with obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension 4-6 and is considered the hepatic manifestation of metabolic syndrome. 7 NAFLD comprises a histological spectrum of nonalcoholic fatty liver (NAFL) characterized by the presence of hepatic steatosis with none or minimal inflammation to nonalcoholic steatohepatitis (NASH), which is characterized by lobular inflammation, ballooning and varying degrees of hepatic fibrosis. 8 Serum liver enzymes, which are often the first clinical clue to presence of liver disease, can be normal or mildly elevated

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Serial combination of non‐invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD

Abstract: The serial combination of LSM with FIB-4/NFS has a good diagnostic accuracy for the non-invasive diagnosis of severe fibrosis in NAFLD.

Cited by 150 publications

References 32 publications

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

Tests for diagnosing and monitoring non-alcoholic fatty liver disease in adults

The role of noninvasive biomarkers in diagnosis and risk stratification in nonalcoholic fatty liver disease

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