A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis (original) (raw)

Abstract

Background

The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) is indeterminate in a proportion of NAFLD patients. Combining the NFS with liver stiffness measurement (LSM) may improve prediction of advanced fibrosis. We aim to evaluate the NFS and LSM in predicting advanced fibrosis in NAFLD patients.

Methods

The NFS was calculated and LSM obtained for consecutive adult NAFLD patients scheduled for liver biopsy. The accuracy of predicting advanced fibrosis using either modality and in combination were assessed. An algorithm combining the NFS and LSM was developed from a training cohort and subsequently tested in a validation cohort.

Results

There were 101 and 46 patients in the training and validation cohort, respectively. In the training cohort, the percentages of misclassifications using the NFS alone, LSM alone, LSM alone (with grey zone), both tests for all patients and a 2-step approach using LSM only for patients with indeterminate and high NFS were 5.0, 28.7, 2.0, 2.0 and 4.0 %, respectively. The percentages of patients requiring liver biopsy were 30.7, 0, 36.6, 36.6 and 18.8 %, respectively. In the validation cohort, the percentages of misclassifications were 8.7, 28.3, 2.2, 2.2 and 8.7 %, respectively. The percentages of patients requiring liver biopsy were 28.3, 0, 41.3, 43.5 and 19.6 %, respectively.

Conclusions

The novel 2-step approach further reduced the number of patients requiring a liver biopsy whilst maintaining the accuracy to predict advanced fibrosis. The combination of NFS and LSM for all patients provided no apparent advantage over using either of the tests alone.

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Acknowledgements

This study was funded by the University of Malaya Research Grant (Project No.: RG536-13HTM).

Compliance with ethical requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. This article does not contain any studies with animal subjects. This study was approved by the University of Malaya Medical Centre’s Ethics Committee and allpatients who participated provided informed consent. Wah-Kheong Chan, Nik Raihan Nik Mustapha, and Sanjiv Mahadeva declare that they have no conflict of interest.

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Authors and Affiliations

  1. Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
    Wah-Kheong Chan & Sanjiv Mahadeva
  2. Department of Pathology, Hospital Alor Setar, Alor Setar, Malaysia
    Nik Raihan Nik Mustapha

Authors

  1. Wah-Kheong Chan
  2. Nik Raihan Nik Mustapha
  3. Sanjiv Mahadeva

Corresponding author

Correspondence toWah-Kheong Chan.

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Chan, WK., Nik Mustapha, N.R. & Mahadeva, S. A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis.Hepatol Int 9, 594–602 (2015). https://doi.org/10.1007/s12072-014-9596-7

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