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Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease
Abstract
Background & aims NAFLD is highly prevalent but only a small subset of patients develop advanced liver fibrosis with impaired liver-related prognosis. We aimed to compare blood fibrosis tests and liver stiffness measurement (LSM) by FibroScan for the diagnosis of liver fibrosis and the evaluation of prognosis in NAFLD.Methods Diagnostic accuracy was evaluated in a cross-sectional study including 452 NAFLD patients with liver biopsy (NASH-CRN fibrosis stage), LSM, and eight blood fibrosis tests (BARD, NAFLD fibrosis score, FibroMeter(NAFLD), aspartate aminotransferase to platelet ratio index (APRI), FIB4, FibroTest, Hepascore, FibroMeter(V2G)). Prognostic accuracy was evaluated in a longitudinal study including 360 NAFLD patients.Results LSM and FibroMeter(V2G) were the two best-performing tests in the cross-sectional study: AUROCs for advanced fibrosis (F3/4) were, respectively, 0.831±0.019 and 0.817±0.020 (p⩽0.041 vs. other tests); rates of patients with ⩾90% negative/positive predictive values for F3/4 were 56.4% and 46.7% (p<0.001 vs. other tests); Obuchowski indexes were 0.834±0.014 and 0.798±0.016 (p⩽0.036 vs. other tests). Two fibrosis classifications were developed to precisely estimate the histological fibrosis stage from LSM or FibroMeter(V2G) results without liver biopsy (diagnostic accuracy, respectively: 80.8% vs. 77.4%, p=0.190). Kaplan-Meier curves in the longitudinal study showed that both classifications categorised NAFLD patients into subgroups with significantly different prognoses (p<0.001): the higher was the class of the fibrosis classification, the worse was the prognosis.Conclusions LSM and FibroMeter(V2G) were the most accurate of nine evaluated tests for the non-invasive diagnosis of liver fibrosis in NAFLD. LSM and FibroMeter(V2G) fibrosis classifications help physicians estimate both fibrosis stage and patient prognosis in clinical practice.Lay summary The amount of liver fibrosis is the main determinant of the liver-related prognosis in patients with non-alcoholic fatty liver disease (NAFLD). We evaluated eight blood tests and FibroScan in a cross-sectional diagnostic study and found that FibroScan and the blood test FibroMeter(V2G) were the two most accurate tests for the non-invasive evaluation of liver fibrosis in NAFLD. A longitudinal prognostic study showed these two tests initially developed for the diagnosis are also prognostic markers as they allow for the stratification of NAFLD patients in several subgroups with significantly different prognosis.
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“FIB-4 can predict liver-related mortality in biopsy-proven or clinically diagnosed MASLD, 178”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [178]
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“Several observational studies showed that LSM had good accuracy for liver-related events, liver-related and overall mortality. 178,183,184”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [178]
Citations
Cites
Design and validation of a histological scoring system for nonalcoholic fatty liver disease†
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“Eight blood fibrosis tests were calculated according to published or patented formulas: NFS (12), BARD (20), FibroMeter NAFLD (21), APRI (22), FIB4 (23), Fibrotest (24), Hepascore (25), and FibroMeter V2G (26).”
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Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210
Berzigotti, A., Tsochatzis, E., Boursier, J., Castera, L., Cazzagon, N., Friedrich-Rust, M., Petta, S., & Thiele, M. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.05.025 · Cited by 1,925
Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease
Castera, L., Friedrich-Rust, M., & Loomba, R. (2019) · Gastroenterology · doi:10.1053/j.gastro.2018.12.036 · Cited by 1,494
Nonalcoholic Fatty Liver Disease 2020: The State of the Disease
Cotter, T. G., & Rinella, M. E. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.01.052 · Cited by 1,226
Dietrich, C., Bamber, J. C., Berzigotti, A., Bota, S. I., Cantisani, V., Castéra, L., Cosgrove, D. O., Ferraioli, G., Friedrich‐Rust, M., Gilja, O. H., et al. (2017) · Ultraschall in der Medizin - European Journal of Ultrasound · doi:10.1055/s-0043-103952 · Cited by 1,016
Metadata
- Authors
- Boursier, J., Vergniol, J., Guillet, A., Hiriart, J.-B., Lannes, A., Le Bail, B., Michalak, S., Chermak, F., Bertrais, S., Foucher, J., Oberti, F., Charbonnier, M., Fouchard-Hubert, I., Rousselet, M.-C., Calès, P., & de Lédinghen, V.
- Affiliations
- Centre Hospitalier Universitaire d'Angers (FR)
- Centre Hospitalier Universitaire de Bordeaux (FR)
- Université d'Angers (FR)
- Université Nantes Angers Le Mans (FR)
- Corresponding author
- Boursier, Jérôme
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 65
- Issue
- 3
- Pages
- 570-578
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2346887577
- Cited by
- 400
- References
- 45
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 40 · 2023: 38 · 2022: 47 · 2021: 60 · 2020: 51 · 2019: 47 · 2018: 35 · 2017: 31 · 2016: 6
- FWCI
- 37.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, liver fibrosis, liver stiffness measurement, FibroScan, noninvasive fibrosis assessment, prognostic accuracy, NAFLD fibrosis score, APRI, FIB-4, fibrosis staging, liver biopsy alternative, liver-related mortality
- MeSH terms
- Biopsy, Cross-Sectional Studies, Humans, Liver Cirrhosis, Longitudinal Studies, Prognosis, Biomarkers, Non-alcoholic Fatty Liver Disease
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