New sequential combinations of non-invasive fibrosis tests provide an accurate diagnosis of advanced fibrosis in NAFLD

JOURNAL OF HEPATOLOGY

卷:71

Article

Boursier, Jerome^1,2  Guillaume, Maeva^3,4  Leroy, Vincent^5,6  Irles, Marie⁷  Roux, Marine²  Lannes, Adrien^1,2  Foucher, Juliette⁷  Zuberbuhler, Floraine^1,2  Delabaudiere, Cyrielle³  Barthelon, Justine⁵  Michalak, Sophie^2,8  Hiriart, Jean-Baptiste⁷  Peron, Jean-Marie^3,4  Gerster, Theophile⁵  Le Bail, Brigitte⁹  Riou, Jeremie¹⁰  Hunault, Gilles²  Merrouche, Wassil⁷  Oberti, Frederic^1,2  Pelade, Laurence⁵  Fouchard, Isabelle^1,2  Bureau, Christophe^3,4  Cales, Paul^1,2  de Ledinghen, Victor^7,11 

[1] CHU Angers, Serv Hepatogastroenterol, Angers, France

[2] Univ Angers, Lab HIFIH, UPRES 3859, SFR 4208, Angers, France

[3] CHU Toulouse, Serv Hepatogastroenterol, Toulouse, France

[4] Federat Hosp Univ IMPACT, Inst CARDIOMET, Toulouse, France

[5] CHU Grenoble Alpes, Serv Hepatogastroenterol, Grenoble, France

[6] Univ Grenoble Alpes, INSERM U1209, Grenoble, France

[7] CHU Bordeaux, Serv Hepatol, Hop Haut Levegue, Pessac, France

[8] CHU Angers, Dept Pathol Tissulaire & Cellulaire, Angers, France

[9] CHU Bordeaux, Hop Pellegrin, Serv Anatomopathol, Pessac, France

[10] Angers Univ, MINT UMR INSERM 1066, CNRS 6021, Angers, France

[11] Univ Bordeaux, INSERM U1053, Bordeaux, France

关键词: Non-alcoholic fatty liver disease;    Fibrosis;    Blood test;    VCTE;    Non-invasive diagnosis;    Algorithm;   

DOI  :  10.1016/j.jhep.2019.04.020

来源: Elsevier

【 摘 要 】

Background & Aims: Advanced liver fibrosis is an important diagnostic target in non-alcoholic fatty liver disease (NAFLD) as it defines the subgroup of patients with impaired prognosis. The non-invasive diagnosis of advanced fibrosis is currently limited by the suboptimal positive predictive value and the grey zone (representing indeterminate diagnosis) of fibrosis tests. Here, we aimed to determine the best combination of non-invasive tests for the diagnosis of advanced fibrosis in NAFLD. Methods: A total of 938 patients with biopsy-proven NAFLD were randomized 2:1 into derivation and validation sets. All patients underwent liver stiffness measurement with vibration controlled transient elastography (VCTE) and blood fibrosis tests (NAFLD fibrosis score, Fibrosis-4 [FIB4], Fibrotest, Hepascore, FibroMeter). FibroMeter(VCTE), which combines VCTE results and FibroMeter markers in a single test, was also calculated in all patients. Results: For the diagnosis of advanced fibrosis, VCTE was significantly more accurate than the blood tests (area under the receiver operating characteristic curve [AUROC]: 0.840 +/- 0.013, p <= 0.005). FibroMeter was the most accurate blood test (AUROC: 0.793 +/- 0.015, p <= 0.017). The combinatory test FibroMeter vcm outperformed VCTE and blood tests (AUROC: 0.866 +/- 0.012, p <= 0.005). The sequential combination of FIB4 then FibroMeter(VCTE) (FIB4-FMVCTE algorithm) or VCTE then FibroMeter(VCTE) (VCTE-FMVCTE algorithm) provided an excellent diagnostic accuracy of 90% for advanced fibrosis, with liver biopsy only required to confirm the diagnosis in 20% of cases. The FIB4-FMVCTE and VCTE-FMVCTE algorithms were significantly more accurate than the pragmatic algorithms currently proposed. Conclusion: The sequential combination of fibrosis tests in the FIB4-FMVCTE and VCTE-FMVCTE algorithms provides a highly accurate solution for the diagnosis of advanced fibrosis in NAFLD. These algorithms should now be validated for the diagnosis of advanced liver fibrosis in diabetology or primary care settings. Lay summary: The evaluation of liver fibrosis is mandatory in non-alcoholic fatty liver disease (NAFLD), as advanced fibrosis identifies the subgroup of patients with impaired prognosis. FibroMeter(VCTE) is a new fibrosis test combining blood markers and the result of vibration controlled transient elastography (VCTE) into a single diagnostic test. Our results show that FibroMeter(VCTE) outperforms other blood fibrosis tests and VCTE alone for the diagnosis of advanced fibrosis in a large multicentric cohort of 938 patients with biopsy-proven NAFLD. Sequential algorithms using a simple blood test or VCTE as a first-line procedure, then FibroMeter(VCTE) as a second-line test accurately classified 90% of patients. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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