Computerized Clinical Decision Support Systems; Opportunities and future trends (original) (raw)
The American journal of gastroenterology, 2014
We used data from population-based studies to determine the accuracy of the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI) in determining individual risk of hepatic steatosis. We also developed a new risk scoring system and validated all three indices using external data. We used data from the Study of Health in Pomerania (SHIP; n=4,222), conducted in North-eastern Germany, to validate the existing scoring systems and to develop our own index. Data from the South German Echinococcus Multilocularis and Internal Diseases in Leutkirch (EMIL) study (n=2,177) were used as an external validation data set. Diagnostic performance was evaluated in terms of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration plots. We applied boosting for generalized linear models to select relevant diagnostic separators. The FLI accurately discriminated patients with fatty liver disease from those without (AUC=0.817) but had poor calibration, in that p...
2014
BACKGROUND: Histopathologic assessment of liver tissue is an essential step in management and follow-up of non-alcoholic fatty liver disease (NAFLD) while inter- and intra-observer variations limit the accuracy of these assessments. OBJECTIVES: The aim of this study was to assess the inter- and intra-observer reproducibility of histopathologic assessment of liver biopsies based on NAFLD activity score (NAS) scoring system. MATERIALS AND METHODS: The anonymous liver biopsy samples of 100 consecutive NAFLD suspected adults were randomly assigned to four pathologists. Then, the samples were randomly reassigned to the pathologists for the second time in a way that each sample would be evaluated by two different pathologists. Biopsies were revisited by their first evaluator after two months. The results were reported based on NAS scoring system. RESULTS: Inter-observer agreement of the pathology scores based on NAS scoring system was acceptable for steatosis, lobular inflammation, and fibrosis, but not for hepatocyte ballooning. The intra-observer agreement was acceptable in all scales, with lowest intra-class correlation observed for lobular inflammation. CONCLUSIONS: NAS scoring system has good overall inter- and intra-observer agreement, but more attention should be given to defining the hepatocyte ballooning and lobular inflammation, and training the pathologists to improve the accuracy of pathology reports.
Inter-observer agreement for detection and grading of hepatic steatosis- An ultrasound based study
2018
Objectives: To determine the inter observer agreement of ultrasound diagnosis of the severity and grading of steatosis in patients with HCV Methods: Patients with HCV were evaluated, from March 2008-August 2010 at Radiology department, Dow Medical College and Civil Hospital Karachi, with ultrasound for detection and grading of steatosis and fibrosis using a standardized set of criteria. The same sets of images were reviewed by the same radiologists 5 years later (2015) for determining the agreement in the grading. Kappa (k) statistics were utilized. Present results were compared with that of the pilot study conducted in 2007 on 100 images. Results: 452 set of images were reviewed by three radiologists, designated A, B and C. The inter observer agreement was satisfactory to good with k=0.8 for no steatosis, 0.4 for mild steatosis, 0.7 for moderate steatosis and 0.9 for severe steatosis. The inter-observer agreement in the pilot study in 2007 had shown k – values of 0.81 for no steat...
Design and validation of a histological scoring system for nonalcoholic fatty liver disease
Hepatology, 2005
Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in the absence of a history of significant alcohol use or other known liver disease. Nonalcoholic steatohepatitis (NASH) is the progressive form of NAFLD. The Pathology Committee of the NASH Clinical Research Network designed and validated a histological feature scoring system that addresses the full spectrum of lesions of NAFLD and proposed a NAFLD activity score (NAS) for use in clinical trials. The scoring system comprised 14 histological features, 4 of which were evaluated semi-quantitatively: steatosis (0-3), lobular inflammation (0-2), hepatocellular ballooning (0-2), and fibrosis (0-4). Another nine features were recorded as present or absent. An anonymized study set of 50 cases (32 from adult hepatology services, 18 from pediatric hepatology services) was assembled, coded, and circulated. For the validation study, agreement on scoring and a diagnostic categorization ("NASH," "borderline," or "not NASH") were evaluated by using weighted kappa statistics. Inter-rater agreement on adult cases was: 0.84 for fibrosis, 0.79 for steatosis, 0.56 for injury, and 0.45 for lobular inflammation. Agreement on diagnostic category was 0.61. Using multiple logistic regression, five features were independently associated with the diagnosis of NASH in adult biopsies: steatosis (P ؍ .009), hepatocellular ballooning (P ؍ .0001), lobular inflammation (P ؍ .0001), fibrosis (P ؍ .0001), and the absence of lipogranulomas (P ؍ .001). The proposed NAS is the unweighted sum of steatosis, lobular inflammation, and hepatocellular ballooning scores. In conclusion, we present a strong scoring system and NAS for NAFLD and NASH with reasonable inter-rater reproducibility that should be useful for studies of both adults and children with any degree of NAFLD. NAS of >5 correlated with a diagnosis of NASH, and biopsies with scores of less than 3 were diagnosed as "not NASH." (HEPATOLOGY 2005;41:1313-1321
Diagnostic accuracy of hepatorenal index in the detection and grading of hepatic steatosis
Journal of clinical ultrasound : JCU, 2016
The objectives of our study were to assess the accuracy of hepatorenal index (HRI) in detection and grading of hepatic steatosis and to evaluate various factors that can affect the HRI measurement. Forty-five patients, who had undergone an abdominal sonographic examination within 30 days of liver biopsy, were enrolled. The HRI was calculated as the ratio of the mean brightness levels of the liver and renal parenchymas. The effect of the measurement technique on the HRI was evaluated by using various sizes, depths, and locations of the regions of interest (ROIs) in the liver. The measurements were obtained by two observers. The HRI was compared with the subjective grading of steatosis. The optimal HRI cutoff to detect steatosis was 2.01, yielding a sensitivity of 62.5% and specificity of 95.2%. Subjective grading had a sensitivity of 87.5% and specificity of 62.5%. HRIs of the hepatic steatosis group were statistically different from the no-steatosis group (p < 0.05). However, the...
Alimentary Pharmacology & Therapeutics, 2021
SummaryBackgroundPatients with non‐alcoholic steatohepatitis (NASH) and fibrosis stage ≥2 comprise a target population for pharmacotherapy. Liver biopsy, the reference standard for identifying this population, requires complete and accurate assessment of steatohepatitis and fibrosis.AimsTo investigate the completeness of real‐world NASH‐related pathology reports, assess concordance between site pathologists and central expert interpretation of the histologic elements of NASH, and determine concordance between biopsy‐diagnosed NASH and a pragmatic clinical definition of NASH.MethodsLiver pathology reports from 222 patients across 38 TARGET‐NASH sites were analysed for documentation of the histologic features of NASH. Biopsy slides were over‐read by a blinded central expert pathologist. Concordance of histologic scores and interpretation was assessed. Histologic concordance with a clinical definition of NASH was determined. TARGET‐NASH clinically defined NASH: elevated ALT, hepatic st...
JHEP Reports
Background & Aims: There is currently no data on physician preferences regarding future therapies for non-alcoholic steatohepatitis (NASH); this study explores these preferences and characteristics that are relevant to physician decisionmaking when choosing a potential therapy for a patient with NASH. The results were compared with those from a similar patient preference survey which was conducted in parallel. Method: Initial exploratory 30-minute telephone interviews were conducted to inform the design of a 15-minute quantitative online specialist physicians survey, containing direct questions and a preference survey. This was based on a best-worst scaling (BWS) experiment to assess the relative importance of different treatment characteristics (attributes), followed by several paired comparison questions to understand the preference for 5 hypothetical product profiles. Results: The answers come from 121 physicians from Canada (n = 31), Germany (n = 30), the UK (n = 30) and the USA (n = 30). The primary driving element in NASH treatment decision-making was efficacy (49.23%), defined as "[hypothetical product] impact on liver status" and "[slowing of] progression to cirrhosis". Physicians reported the common use of noninvasive NASH diagnostic tests and 81% reported performing liver biopsy. In 57% of cases, physicians reported that "concerns related to the available diagnostic methods" limit the number of patients with biopsy-confirmed NASH. Conclusions: This first physician preference study reveals that efficacy will be the main driver for physicians in selecting future NASH drugs. The findings also confirm the widespread use of non-invasive diagnostic tests and the reluctance to perform confirmatory liver biopsy despite guideline recommendations, mainly due to limited therapeutic options and patient refusal.
Annals of Diagnostic Pathology, 2011
Accurate and reproducible interpretation of nonalcoholic fatty liver disease (NAFLD) histology has significant clinical and research-related implications. We evaluated the impact of 2 interventions ([1] review of illustrative histologic images of NAFLD with the study pathologists; [2] use of a scoring sheet with written diagnostic criteria for different NAFLD phenotypes) on intra-and interobserver agreement on interpretation of NAFLD histology. Before and after the interventions, 2 pathologists twice read 65 liver biopsies done for evaluation of suspected NAFLD. The intra-and interobserver agreement was highest on assessment of steatosis and fibrosis. The interventions significantly improved the intraobserver agreement only on assessment of hepatocellular ballooning. The interobserver agreement was only fair on assessment of lobular inflammation, ballooning, and diagnostic classification and did not improve after the interventions. Methods to improve interobserver agreement on assessment of lobular inflammation and ballooning are needed and would likely increase pathologists' agreement on NAFLD diagnostic classification.
Speed of sound index for liver steatosis estimation: a reliability study in normal subjects
Diagnostic and interventional radiology, 2022
Non-alcoholic fatty liver disease (NAFLD) is the most widespread type of chronic liver disease in the Western countries. Ultrasound (US) is widely used for NAFLD staging. The Resona 7 US system (Mindray Bio-Medical Electronics Co., Ltd.) includes an image optimization and speed of ultrasound-related feature, Sound Speed Index (SSI). SSI is applied in a region of interest (ROI) that could potentially aid in tissue characterization. The purpose of this study is to evaluate the reliability of SSI on various examination parameters on normal subjects. METHODS Twenty normal subjects were examined by two radiologists performing SSI measurements in the liver in different ROI depths and sizes. Intraclass correlation coefficient (ICC) was calculated to measure intra-and inter-observer variability and inter-ROI variability. RESULTS For all ROIs and both radiologists, the mean inter-observer ICC was 0.62 and the mean intraobserver ICC was 0.52 and 0.79. The mean SSI values for all ROIs and examiners were in the range 1528.79-1540.16 m/s. CONCLUSION The results indicate that SSI can lead to reliable measurements on normal subjects, independent of ROI size but dependent on ROI placement. More studies processing NAFLD patients, utilizing reference methods of liver fat quantification either for reliability or correlation with SSI, should be performed to further investigate the relevance of the SSI as a potential biomarker in clinical practice for liver steatosis grading. C hronic liver disease (CLD) is responsible for approximately 2 million deaths/year worldwide, 1 million of which is due to cirrhosis-related complications and 1 million is due to hepatitis B, C, and hepatocellular carcinoma (HCC). 1 About 2 billion people consume alcohol in regular basis worldwide, and more than 75 million are diagnosed with alcohol-use disorders and are at risk of alcohol-associated liver disease (AALD). Approximately 2 billion adults are obese or overweight and over 400 million have diabetes, which are risk factors for non-alcoholic fatty liver disease (NAFLD) and HCC. 2 Specifically, AALD and NAFLD are the main causes of CLD in Western countries. 3 Significant alcohol consumption or unhealthy dietary patterns may lead to alcoholic or non-alcoholic steatohepatitis (NASH), cirrhosis, and HCC. 4,5 AALD, NAFLD, and NASH are developed due to liver tissue inflammation caused by hepatic steatosis (HS). The term HS includes a wide range of pathological situations that involve triglyceride accumulation into the hepatocyte cytoplasm. HS is commonly observed in clinical practice, and its prevalence is increasing along with the pandemics of obesity and type 2 diabetes mellitus. 6 As the presence of HS may lead to increased probability for development of various clinically important diseases, methods for its accurate assessment in terms of existence and severity are needed. Liver biopsy (LB), despite being considered as the "Reference Standard" in diagnosing NASH existence and HS severity, 7 has serious limitations. LB is an invasive procedure causing post-operative complications to nearly 30% of patients 8 and is characterized by significant