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Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage.

Publication ,  Journal Article
Siddiqui, MS; Yamada, G; Vuppalanchi, R; Van Natta, M; Loomba, R; Guy, C; Brandman, D; Tonascia, J; Chalasani, N; Neuschwander-Tetri, B ...
Published in: Clin Gastroenterol Hepatol
August 2019

BACKGROUND & AIMS: Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. METHODS: We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. RESULTS: In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). CONCLUSIONS: In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.

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Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

August 2019

Volume

17

Issue

9

Start / End Page

1877 / 1885.e5

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Sensitivity and Specificity
  • Retrospective Studies
  • Predictive Value of Tests
  • Platelet Count
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Liver
 

Citation

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Siddiqui, M. S., Yamada, G., Vuppalanchi, R., Van Natta, M., Loomba, R., Guy, C., … NASH Clinical Research Network. (2019). Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage. Clin Gastroenterol Hepatol, 17(9), 1877-1885.e5. https://doi.org/10.1016/j.cgh.2018.12.031
Siddiqui, Mohammad Shadab, Goro Yamada, Raj Vuppalanchi, Mark Van Natta, Rohit Loomba, Cynthia Guy, Danielle Brandman, et al. “Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage.Clin Gastroenterol Hepatol 17, no. 9 (August 2019): 1877-1885.e5. https://doi.org/10.1016/j.cgh.2018.12.031.
Siddiqui MS, Yamada G, Vuppalanchi R, Van Natta M, Loomba R, Guy C, et al. Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1877-1885.e5.
Siddiqui, Mohammad Shadab, et al. “Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage.Clin Gastroenterol Hepatol, vol. 17, no. 9, Aug. 2019, pp. 1877-1885.e5. Pubmed, doi:10.1016/j.cgh.2018.12.031.
Siddiqui MS, Yamada G, Vuppalanchi R, Van Natta M, Loomba R, Guy C, Brandman D, Tonascia J, Chalasani N, Neuschwander-Tetri B, Sanyal AJ, NASH Clinical Research Network. Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage. Clin Gastroenterol Hepatol. 2019 Aug;17(9):1877-1885.e5.
Journal cover image

Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

August 2019

Volume

17

Issue

9

Start / End Page

1877 / 1885.e5

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Sensitivity and Specificity
  • Retrospective Studies
  • Predictive Value of Tests
  • Platelet Count
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Liver