ABSTRACT
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. India and other developing countries are witnessing an unprecedented rise in the prevalence of NAFLD. As part of population-level strategy, at primary healthcare, an efficient risk stratification is crucial to ensure appropriate and timely referral of individuals who require care at secondary and tertiary levels. The present study was conducted to assess the diagnostic performance of two non-invasive risk scores, fibrosis-4 (FIB-4), and NAFLD fibrosis score (NFS), in Indian patients of biopsy-proven NAFLD. METHODS: We conducted a retrospective analysis of biopsy-proven NAFLD patients that reported to our center between 2009 and 2015. Clinical and laboratory data were collected and two non-invasive fibrosis scores, NFS and FIB-4 score, were calculated using the original formulas. Liver biopsy was utilized as gold standard for diagnosis of NAFLD, diagnostic performance was determined by plotting receiver operator characteristic (ROC) curves and area under the ROC curve (AUROC) was calculated for each score. RESULTS: The mean age of 272 patients included was 40 (11.85) years and 187 (79.24%) were men. We found that the AUROCs for FIB-4 score (0.634) was higher for any degree of fibrosis as compared to NFS (0.566). The AUROC for FIB-4 for advanced liver fibrosis was 0.640 (.550-.730). The performance of the scores for advanced liver fibrosis was comparable with overlapping confidence intervals for both scores. CONCLUSION: The present study found an average performance of FIB-4 and NFS risk scores for detecting advanced liver fibrosis in Indian population. This study highlights the need for devising novel context-specific risk scores for efficient risk stratification of NAFLD patients in India.
Subject(s)
Non-alcoholic Fatty Liver Disease , Male , Humans , Female , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/complications , Retrospective Studies , Biomarkers , Liver Cirrhosis/diagnosis , Liver Cirrhosis/epidemiology , Liver Cirrhosis/pathology , Risk Factors , Fibrosis , Biopsy , Liver/pathology , Severity of Illness IndexABSTRACT
Objective:To investigate the possible role of non-invasive fibrosis scoring systems for detecting high-risk plaque among patients with non-alcoholic fatty liver disease (NAFLD).Methods:A total of 477 consecutive asymptomatic subjects underwent a health checkup including coronary computed tomography angiography (CTA) and abdominal ultrasonography. Fatty liver was evaluated using ultrasonography, and the NAFLD fibrosis score (NFS) was calculated. Coronary stenosis and plaque were evaluated using coronary CTA.Results:Of the study population, 223 had NAFLD. Among the NAFLD patients, high-risk coronary plaque was more frequent in patients with high or intermediate NFS than those with low NFS (62.5% versus 24.0%, P<0.001). The adjusted odds ratio with 95% confidence interval of high-risk plaque was 3.24 (1.11-9.40) for the highest versus lowest quartile of NFS ( P=0.016). Among those without NAFLD, NFS was not associated with high-risk coronary plaque (C-statistic with NFS versus without NFS, 0.766 versus 0.764, P=0.715). Adding NFS to the traditional cardiovascular disease (CVD) risk model increased the C-statistics by 0.679 to 0.739 ( P=0.031). Conclusions:There was an independent association of NFS with high-risk coronary plaque in patients with NAFLD, suggesting its potential use to optimize management of patients with NAFLD.
ABSTRACT
Background: Esophageal vein rebleeding is a life-threatening complication of liver cirrhosis. However, the role of non-invasive methods that were developed to evaluate the severity of chronic liver disease, especially in rebleeding, remains unclear. Aims: To evaluate the performance of liver stiffness and non-invasive fibrosis scores in predicting esophageal vein rebleeding in hepatitis B virus (HBV) cirrhotic patients. Methods: A prospective analysis of 194 HBV patients between 2017 and 2021 was performed. Receiver operating characteristic (ROC) curves and time-dependent ROC curves were used to assess the power for predicting rebleeding with non-invasive fibrosis score and liver stiffness. Results: During the median follow-up time of 68.28 weeks, 55 patients experienced rebleeding. In the entire cohort, the area under the ROC curve for liver stiffness measurement (LSM) predicting for rebleeding was 0.837, with a cut-off value of 17.79 kPa, and the time-dependent ROC curve also showed stable prediction performance of LSM. The predictive ability of the non-invasive fibrosis score was less than that of LSM, and there were statistical differences. Moreover, patients using non-selective beta-blockers and HBV DNA-negative patients experienced significantly reduced rebleeding. Conclusions: Compared with non-invasive fibrosis scores, LSM can more simply and accurately predict rebleeding events of hepatitis B liver cirrhosis.
