Non-laboratory-based self-assessment screening score for non-alcoholic fatty liver disease: development, validation and comparison with other scores - PubMed (original) (raw)

Non-laboratory-based self-assessment screening score for non-alcoholic fatty liver disease: development, validation and comparison with other scores

Yong-ho Lee et al. PLoS One. 2014.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent and rapidly increasing disease worldwide; however, no widely accepted screening models to assess the risk of NAFLD are available. Therefore, we aimed to develop and validate a self-assessment score for NAFLD in the general population using two independent cohorts.

Methods: The development cohort comprised 15676 subjects (8313 males and 7363 females) who visited the National Health Insurance Service Ilsan Hospital in Korea in 2008-2010. Anthropometric, clinical, and laboratory data were examined during regular health check-ups and fatty liver diagnosed by abdominal ultrasound. Logistic regression analysis was conducted to determine predictors of prevalent NAFLD and to derive risk scores/models. We validated our models and compared them with other existing methods using an external cohort (N = 66868).

Results: The simple self-assessment score consists of age, sex, waist circumference, body mass index, history of diabetes and dyslipidemia, alcohol intake, physical activity and menopause status, which are independently associated with NAFLD, and has a value of 0-15. A cut-off point of ≥ 8 defined 58% of males and 36% of females as being at high-risk of NAFLD, and yielded a sensitivity of 80% in men (77% in women), a specificity of 67% (81%), a positive predictive value of 72% (63%), a negative predictive value of 76% (89%) and an AUC of 0.82 (0.88). Comparable results were obtained using the validation dataset. The comprehensive NAFLD score, which includes additional laboratory parameters, has enhanced discrimination ability, with an AUC of 0.86 for males and 0.91 for females. Both simple and comprehensive NAFLD scores were significantly increased in subjects with higher fatty liver grades or severity of liver conditions (e.g., simple steatosis, steatohepatitis).

Conclusions: The new non-laboratory-based self-assessment score may be useful for identifying individuals at high-risk of NAFLD. Further studies are warranted to evaluate the utility and feasibility of the scores in various settings.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1

Figure 1. Estimated prevalence of NAFLD according to screening score: development and external validation datasets.

A, development dataset (N = 15676); B, external validation dataset (N = 66868).

Figure 2

Figure 2. Sample self-assessment screening questionnaire.

Figure 3

Figure 3. Average scores for the simple and comprehensive models according to fatty liver grade determined by hepatic ultrasound or NAFLD fibrosis score.

Average scores for A) the simple model or B) the comprehensive model according to fatty liver grade determined by hepatic ultrasound. All P values of comparison between any groups are <0.001. *P for trend are <0.001. Average scores for C) the simple model or D) the comprehensive model according to the fatty liver conditions defined by NAFLD fibrosis score. Subjects with negative results by NAFLD fibrosis score (N = 12046) could be excluded from having advanced fibrosis and subjects with positive results of NAFLD fibrosis score (N = 131) are highly likely to have advanced fibrosis. All P values of comparison between any groups are <0.001. *P for trend are <0.001. Data are shown as mean with SD.

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