Salvatore Petta1, Ester Vanni2, Elisabetta Bugianesi2, V. Di Marco2, Calogero Cammà1, Daniela Cabibi3, L. Mezzabotta2, Antonio Craxı̀1
1Sezione di Gastroenterologia, DiBiMIS; University of Palermo; Palermo Italy
2Division of Gastro-Hepatology; Department of Internal Medicine; San Giovanni Battista Hospital; University of Torino; Torino Italy
3Cattedra di Anatomia Patologica, University of Palermo, Palermo, Italy
Tóm tắt
AbstractBackground & AimsThe accuracy of noninvasive tools for the diagnosis of severe fibrosis in patients with nonalcoholic fatty liver disease(NAFLD) in clinical practice is still limited. We aimed at assessing the diagnostic performance of combined noninvasive tools in two independent cohorts of Italian NAFLD patients.MethodsWe analysed data from 321 Italian patients(179 Sicilian‐training cohort, and 142 northern Italy‐validation cohort) with an histological diagnosis of NAFLD. Severe fibrosis was defined as fibrosis ≥ F3 according to Kleiner classification. The APRI, AST/ALT, BARD, FIB‐4, and NFS scores were calculated according to published algorithms. Liver stiffness measurement(LSM) was performed by FibroScan. Cut‐off points of LSM, NFS and FIB‐4 for rule‐in or rule‐out F3‐F4 fibrosis were calculated by the reported formulas.ResultsIn the Sicilian cohort AUCs of LSM, NFS, FIB‐4, LSM plus NFS, LSM plus FIB‐4, and NFS plus FIB‐4 were 0.857, 0.803, 0.790, 0.878, 0.888 and 0.807, respectively, while in the northern Italy cohort the corresponding AUCs were 0.848, 0.730, 0.703, 0.844, 0.850, and 0.733 respectively. In the training cohort, the combination of LSM plus NFS was the best performing strategy, providing false positive, false negative and uncertainty area rates of 0%,1.1% and 48% respectively. Similar results were obtained in the validation cohort with false positive, false negative and uncertainty area rates of 0%,7.3% and 40.8%.ConclusionsThe combination of LSM with NFS, two complementary, easy‐to‐perform, and widely available tools, is able to accurately diagnose or exclude the presence of severe liver fibrosis, also reducing of about 50–60% the number of needed diagnostic liver biopsies.
