Pennisi, Grazia and Enea, Marco and Falco, Vincenzo and Aithal, Guruprasad P. and Palaniyappan, Naaventhan and Yilmaz, Yusuf and Boursier, Jerome and Cassinotto, Christophe and de Ledinghen, Victor and Chan, Wah Kheong and Mahadeva, Sanjiv and Eddowes, Peter and Newsome, Philip and Karlas, Thomas and Wiegand, Johannes and Wong, Vincent Wai-Sun and Schattenberg, Joern M. and Labenz, Christian and Kim, Won and Lee, Myoung Seok and Lupsor-Platon, Monica and Cobbold, Jeremy F. L. and Fan, Jian-Gao and Shen, Feng and Staufer, Katharina and Trauner, Michael and Stauber, Rudolf and Nakajima, Atsushi and Yoneda, Masato and Bugianesi, Elisabetta and Younes, Ramy and Gaia, Silvia and Zheng, Ming-Hua and Camma, Calogero and Anstee, Quentin M. and Mozes, Ferenc E. and Pavlides, Michael and Petta, Salvatore (2023) Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes. Hepatology International, 78 (1). pp. 195-211. ISSN 1936-0533, DOI https://doi.org/10.1097/HEP.0000000000000351.
Full text not available from this repository.Abstract
Background and Aims: We evaluated the diagnostic accuracy of simple, noninvasive tests (NITs) in NAFLD patients with type 2 diabetes (T2D).Methods and Results: This was an individual patient data meta-analysis of 1780 patients with biopsy-proven NAFLD and T2D. The index tests of interest were FIB-4, NAFLD Fibrosis Score (NFS), aspartate aminotransferase-to-platelet ratio index, liver stiffness measurement (LSM) by vibration-controlled transient elastography, and AGILE 3+. The target conditions were advanced fibrosis, NASH, and fibrotic NASH(NASH plus F2-F4 fibrosis). The diagnostic performance of noninvasive tests. individually or in sequential combination, was assessed by area under the receiver operating characteristic curve and by decision curve analysis. Comparison with 2278 NAFLD patients without T2D was also made. In NAFLD with T2D LSM and AGILE 3+ outperformed, both NFS and FIB-4 for advanced fibrosis (area under the receiver operating characteristic curve:LSM 0.82, AGILE 3+ 0.82, NFS 0.72, FIB-4 0.75, aspartate aminotransferase-to-platelet ratio index 0.68; p < 0.001 of LSM-based versus simple serum tests), with an uncertainty area of 12%-20%. The combination of serum-based with LSM-based tests for advanced fibrosis led to a reduction of 40%-60% in necessary LSM tests. Decision curve analysis showed that all scores had a modest net benefit for ruling out advanced fibrosis at the risk threshold of 5%-10% of missing advanced fibrosis. LSM and AGILE 3+ outperformed both NFS and FIB-4 for fibrotic NASH (area under the receiver operating characteristic curve:LSM 0.79, AGILE 3+ 0.77, NFS 0.71, FIB-4 0.71; p < 0.001 of LSM-based versus simple serum tests). All noninvasive scores were suboptimal for diagnosing NASH.Conclusions: LSM and AGILE 3+ individually or in low availability settings in sequential combination after FIB-4 or NFS have a similar good diagnostic accuracy for advanced fibrosis and an acceptable diagnostic accuracy for fibrotic NASH in NAFLD patients with T2D.
| Item Type: | Article |
|---|---|
| Funders: | Ministry of Education, Universities and Research (MIUR) PE00000019 CUP B73C22001250006, Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under Grant Agreement 777377, European Union (EU), Newcastle NIHR Biomedical Research Centre, National Institutes of Health Research (NIHR), Ministero della Salute Italiana PNRR-MAD-2022-12375656.r, Ministero della Salute Italiana project PNRR-MAD-2022-12375656 |
| Uncontrolled Keywords: | Accurately identifies patients; Decision curve analysis; Fibrosis |
| Subjects: | R Medicine > RC Internal medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 08 Nov 2025 10:40 |
| Last Modified: | 08 Nov 2025 10:40 |
| URI: | http://eprints.um.edu.my/id/eprint/49746 |
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