Comparative Assessment and External Validation of Hepatic Steatosis Formulae in a Community-Based Setting - PubMed (original) (raw)

Comparative Assessment and External Validation of Hepatic Steatosis Formulae in a Community-Based Setting

Tae Yang Jung et al. J Clin Med. 2020.

Abstract

Several hepatic steatosis formulae have been validated in various cohorts using ultrasonography. However, none of these studies has been validated in a community-based setting using the gold standard method. Thus, the aim of this study was to externally validate hepatic steatosis formulae in community-based settings using magnetic resonance imaging (MRI). A total of 1301 community-based health checkup subjects who underwent liver fat quantification with MRI were enrolled in this study. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUROC). Non-alcoholic fatty liver disease (NAFLD) liver fat score showed the highest diagnostic performance with an AUROC of 0.72, followed by Framingham steatosis index (0.70), hepatic steatosis index (HSI, 0.69), ZJU index (0.69), and fatty liver index (FLI, 0.68). There were considerable gray zones in three fatty liver prediction models using two cutoffs (FLI, 28.9%; HSI, 48.9%; and ZJU index, 53.6%). The diagnostic performance of NAFLD liver fat score for detecting steatosis was comparable to that of ultrasonography. The diagnostic agreement was 72.7% between NAFLD liver fat score and 70.9% between ultrasound and MRI. In conclusion, the NAFLD liver fat score showed the best diagnostic performance for detecting hepatic steatosis. Its diagnostic performance was comparable to that of ultrasonography in a community-based setting.

Keywords: fatty liver; magnetic resonance imaging; non-alcoholic fatty liver disease; population groups; validation study.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1

Figure 1

Flow chart showing enrollment of participants for this study. * NAFLD = Non-alcoholic fatty liver disease. Fatty liver was defined as hepatic fat fraction ≥5% on magnetic resonance imaging.

Figure 2

Figure 2

Area under the receiver operator characteristics (AUROC) of each prediction model for predicting fatty liver.

Figure 3

Figure 3

Box plot of each prediction model: (a) NAFLD liver fat score, (b) fatty liver index (FLI), (c) hepatic steatosis index (HSI), (d) ZJU index, and (e) Framingham steatosis index (FSI)) for predicting fatty liver according to the degree of hepatic steatosis. The yellow box represents the interquartile range and the black line across the box indicates the median. “Whiskers” are black lines that extend from the box to the highest and lowest values, excluding outliers (dots).

Figure 4

Figure 4

Concordance of fatty liver diagnosis with ultrasound (a) and non-alcoholic fatty liver disease liver fat score (b) in comparison with magnetic resonance imaging. TP: true-positive; TN: true-negative; FP: false-positive; and FN: false-negative.

Figure 5

Figure 5

Proportions of gray zones among estimated formulae using two cutoffs.

References

    1. Estes C., Chan H.L.Y., Chien R.N., Chuang W.L., Fung J., Goh G.B., Hu T.H., Huang J.F., Jang B.K., Jun D.W., et al. Modelling NAFLD disease burden in four Asian regions-2019–2030. Aliment Pharm. Ther. 2020 doi: 10.1111/apt.15673. - DOI - PMC - PubMed
    1. Huang X., Xu M., Chen Y., Peng K., Huang Y., Wang P., Ding L., Lin L., Xu Y., Chen Y., et al. Validation of the Fatty Liver Index for Nonalcoholic Fatty Liver Disease in Middle-Aged and Elderly Chinese. Medicine. 2015;94:e1682. doi: 10.1097/MD.0000000000001682. - DOI - PMC - PubMed
    1. Koehler E.M., Schouten J.N., Hansen B.E., Hofman A., Stricker B.H., Janssen H.L. External validation of the fatty liver index for identifying nonalcoholic fatty liver disease in a population-based study. Clin. Gastroenterol. Hepatol. 2013;11:1201–1204. doi: 10.1016/j.cgh.2012.12.031. - DOI - PubMed
    1. Meffert P.J., Baumeister S.E., Lerch M.M., Mayerle J., Kratzer W., Volzke H. Development, external validation, and comparative assessment of a new diagnostic score for hepatic steatosis. Am. J. Gastroenterol. 2014;109:1404–1414. doi: 10.1038/ajg.2014.155. - DOI - PubMed
    1. Shen Y.N., Yu M.X., Gao Q., Li Y.Y., Huang J.J., Sun C.M., Qiao N., Zhang H.X., Wang H., Lu Q., et al. External validation of non-invasive prediction models for identifying ultrasonography-diagnosed fatty liver disease in a Chinese population. Medicine. 2017;96:e7610. doi: 10.1097/MD.0000000000007610. - DOI - PMC - PubMed

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