The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.
A Sequential Algorithm Combining ADAPT and Liver Stiffness Can Stage Metabolic-Associated Fatty Liver Disease in Hospital-Based and Primary Care Patients
Abstract
INTRODUCTION: Metabolic-associated fatty liver disease is common, with fibrosis the major determinant of adverse outcomes. Population-based screening tools with high diagnostic accuracy for the staging of fibrosis are lacking. METHODS: Three independent cohorts, 2 with both liver biopsy and liver stiffness measurements (LSMs, n = 254 and 65) and a population sample (n = 713), were studied. The performance of a recently developed noninvasive algorithm (ADAPT [age, diabetes, PRO-C3 and platelets panel]) as well as aspartate aminotransferase-to-platelet ratio index, fibrosis-4, nonalcoholic fatty liver disease fibrosis score, and LSM was used to stage patients for significant (≥F2) and advanced (≥F3) fibrosis. RESULTS: In the hospital-based cohorts, the N-terminal propeptide of type 3 collagen (Pro-C3) increased with fibrosis stage (P < 0.0001) and independently associated with advanced fibrosis (odds ratio = 1.091, 95% confidence interval [CI]: 1.053-1.113, P = 0.0001). ADAPT showed areas under the receiver operating characteristics curve of 0.831 (95% CI: 0.779-0.875) in the derivation and 0.879 (95% CI: 0.774-0.946) in the validation cohort for advanced fibrosis. This was superior to the existing fibrosis scores, aspartate aminotransferase-to-platelet ratio index, fibrosis-4, BARD (BMI, aspartate aminotransferase to alanine aminotransferase ratio [AAR], diabetes), and nonalcoholic fatty liver disease fibrosis score in most comparisons and comparable with LSM. Serial use of ADAPT and LSM had diagnostic accuracy of 92.5%, with 98% and 100% negative predictive value in the derivation and validation cohorts, respectively. In the population cohort, PRO-C3 associated with advanced fibrosis (P = 0.04), while ADAPT had a negative predictive value of 98% for excluding advanced fibrosis. DISCUSSION: PRO-C3 and ADAPT reliably exclude advanced fibrosis in low-risk populations. The serial combination of ADAPT with LSM has high diagnostic accuracy with a low requirement for liver biopsy. The proposed algorithm would help stratify those who need biopsies and narrow down those patients who would need to be referred to specialty clinics.
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“ADAPT -including age, presence of diabetes, PRO-C3, and platelet count -has recently shown relatively high performance in identifying MASLD with advanced fi brosis in the tertiary hepatology care setting, 148 and in ruling out advanced fi brosis in low-risk populations.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [149]
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- Vilar-Gomez, 2018, Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease, Gastroenterology, 155, 443, 10.1053/j.gastro.2018.04.034 · DOI · Paper page
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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
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Metadata
- Authors
- Eslam, M., Wong, G. L.-H., Hashem, A. M., Chan, H. L.-Y., Nielsen, M. J., Leeming, D. J., Chan, A. W.-H., Chen, Y., Duffin, K. L., Karsdal, M., Schattenberg, J. M., George, J., & Wong, V. W.-S.
- Affiliations
- The University of Sydney (AU)
- Chinese University of Hong Kong (HK)
- Minia University (EG)
- Nordic Bioscience (Denmark) (DK)
- Eli Lilly (United States) (US)
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Wong, Grace Lai-Hung
- George, Jacob
- Wong, Vincent Wai-Sun
- ORCID
- Venue
- American Journal of Gastroenterology
- Published
- 2020-11-26
- Volume
- 116
- Issue
- 5
- Pages
- 984-993
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W3107442854
- Cited by
- 53
- References
- 38
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 8 · 2023: 8 · 2022: 8 · 2021: 10
- FWCI
- 4.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- metabolic-associated fatty liver disease, liver fibrosis staging, liver stiffness measurement, noninvasive fibrosis assessment, aspartate aminotransferase to platelet ratio index, BARD score, primary care screening, hospitalized patients
- MeSH terms
- Age Factors, Algorithms, Aspartate Aminotransferases, Biopsy, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Platelet Count, Predictive Value of Tests, Biomarkers, Collagen Type III, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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