Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments
Open accessAbstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) affects 15-40% of the general population. Some patients have non-alcoholic steatohepatitis (NASH) and progressive fibrosis, and would be candidates for monitoring and treatment. AIM: To review current literature on the use of non-invasive tests to assess the severity of NAFLD. METHODS: Systematic literature searching identified studies evaluating non-invasive tests of NASH and fibrosis using liver biopsy as the reference standard. Meta-analysis was performed for areas with adequate number of publications. RESULTS: Serum tests and physical measurements like transient elastography (TE) have high negative predictive value (NPV) in excluding advanced fibrosis in NAFLD patients. The NAFLD fibrosis score comprises of six routine clinical parameters and has been endorsed by current American guidelines as a screening test to exclude low-risk individuals. The pooled sensitivities and specificities for TE to diagnose F ≥ 2, F ≥ 3 and F4 disease were 79% and 75%, 85% and 85%, and 92% and 92% respectively. Liver stiffness measurement often fails in obese patients, but the success rate can be improved with the use of the XL probe. A number of biomarkers have been developed for the diagnosis of NASH, but few were independently validated. Serum/plasma cytokeratin-18 fragments have been most extensively evaluated and have a pooled sensitivity of 66% and specificity of 82% in diagnosing NASH. CONCLUSIONS: Current non-invasive tests are accurate in excluding advanced fibrosis in NAFLD patients, and may be used for initial assessment. Further development and evaluation of NASH biomarkers are needed.
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Adults with class 2 obesity cannot be reliably examined with many ultrasound techniques.
“Unfortunately, adults with class 2 obesity cannot be reliably examined with many of these ultrasound techniques.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [156]
The Discussion on TE (page unavailable) says obesity is the main reason liver-stiffness measurements fail, supporting a reliability concern for one ultrasound-based technique. It does not single out adults with class 2 obesity or establish that many ultrasound techniques cannot examine them reliably; it also says an XL probe largely overcomes the measurement problem. (LLM, conf=0.84)
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- Grigorescu M, Crisan D, Radu C, Grigorescu MD, Sparchez Z, Serban A. A novel pathophysiological-based panel of biomarkers for the diagnosis of nonalcoholic steatohepatitis. J Physiol Pharmacol 2012; 63: 347-53.
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- Authors
- Kwok, R., Tse, Y. ‐., Wong, G. L. ‐., Ha, Y., Lee, A. U., Ngu, M. C., Chan, H. L. ‐., & Wong, V. W. ‐.
- Affiliations
- Chinese University of Hong Kong (HK)
- Asan Medical Center (KR)
- Concord Repatriation General Hospital (AU)
- Corresponding author
- Wong, G. L.‐H.
- Wong, V. W.‐S.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2013-12-05
- Volume
- 39
- Issue
- 3
- Pages
- 254-269
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2073137449
- Cited by
- 405
- References
- 116
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 33 · 2023: 20 · 2022: 40 · 2021: 33 · 2020: 52 · 2019: 40 · 2018: 31 · 2017: 42 · 2016: 38 · 2015: 34 · 2014: 17
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hong Kong Government
- Topics
- Health Sciences › Medicine › Epidemiology › 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, nonalcoholic steatohepatitis, liver fibrosis, transient elastography, liver stiffness measurement, cytokeratin-18 fragments, NAFLD fibrosis score, non-invasive diagnosis, serum biomarkers, liver biopsy
- MeSH terms
- Biopsy, Fatty Liver, Humans, Liver Cirrhosis, Obesity, Sensitivity and Specificity, Biomarkers, Keratin-18, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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