scholarly journals Validity of routine biochemical and ultrasound scores for prediction of hepatic fibrosis and steatosis in NAFLD

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rasha Eletreby ◽  
Zeinab Abdellatif ◽  
Yasmine Gaber ◽  
Ahmed Ramadan ◽  
Naglaa Ahmad ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Roc Curves ◽  
Significant Fibrosis ◽  
Simple Steatosis ◽  
Fatty Liver Index ◽  
Nafld Fibrosis Score ◽  
Ultrasound Findings ◽  
Hepatic Steatosis Index ◽  
Visceral Adipose ◽  
Better Than

Abstract Background We evaluated the validity of some non-invasive scores and ultrasound findings to predict fibrosis and steatosis in a cohort of NAFLD patients who underwent liver biopsy. Ninety-seven NAFLD patients were enrolled and classified into NASH (66) and simple steatosis groups (31) based on liver biopsy. ROC curves were constructed for Fibrosis-4 index (FIB4), aspartate aminotransferase to platelet ratio index (APRI), and NAFLD fibrosis score (NFS) in fibrosis prediction, also for (hepatic steatosis index; HSI, fatty liver index; FLI) and ultrasonographic subcutaneous and visceral adipose tissue measurements (SAT and VAT) for steatosis prediction. Results FIB4 had AUC of 0.6, APRI and NFS at cutoffs of 0.3 and -.2.4 had AUC of 0.64 and 0.63 in detecting the presence of any grade of fibrosis, and of (0.52, 0.55, and 0.58) for significant fibrosis. FIB4 at a cut-off of (0.76) had the highest AUC in detecting any grade of fibrosis in the simple steatosis group (0.81). SAT (at cutoff of 2.1 and 2.5) was superior to VAT. HSI (at cutoff 45.35 and 45.7) was superior to FLI in detecting moderate or marked steatosis. Conclusion FIB4 and NFS can be used in screening for silent liver disease with ongoing fibrosis in simple steatosis. They are unsatisfactory predictors for significant fibrosis in NAFLD. SAT is better than VAT in predicting moderate steatosis and is slightly better than biochemical HSI.

scholarly journals Higher cut-off values of non-invasive methods might be needed to detect moderate-to-severe steatosis in morbid obese patients: a pilot study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Daniella Braz Parente ◽  
Hugo Perazzo ◽  
Fernando Fernandes Paiva ◽  
Carlos Frederico Ferreira Campos ◽  
Carlos José Saboya ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Liver Biopsy ◽  
Liver Steatosis ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Youden Index ◽  
Resonance Spectroscopy ◽  
Non Invasive ◽  
Fatty Liver Index ◽  
Hepatic Steatosis Index

Abstract To evaluate the diagnostic value of described thresholds of controlled attenuation parameter (CAP) and biomarker scores for liver steatosis and to evaluate new cut-offs to detect moderate-to-severe steatosis (S2–3) in patients with morbid obesity. In this prospective study, 32 patients with morbid obesity with indications for bariatric surgery (15 women and 17 men, mean age = 36 years, median BMI = 40.2 kg/m2) underwent CAP, magnetic resonance spectroscopy (MRS), three biomarker scores (Steato-ELSA, Fatty Liver Index (FLI), and Hepatic Steatosis Index (HSI)), and liver biopsy. Subjects were divided into an exploratory cohort (reliable CAP and liver biopsy) and a confirmatory cohort (reliable CAP and MRS) to evaluate new thresholds for CAP and biomarker scores to detect S2–3. Receiver operator characteristic (ROC) curves analyses were performed and the optimal cut-off points were identified using the maximal Youden index. A total of 22 patients had CAP measure and liver biopsy (exploratory cohort) and 24 patients had CAP measure with MRS (confirmatory cohort). New cut-offs were identified for detection of S2–3 by the non-invasive tests using liver biopsy as the reference standard (exploratory cohort). Considering the new proposed cut-offs for detection of S2–3 for CAP (≥ 314 dB/m), Steato-ELSA (≥ 0.832), FLI (≥ 96), and HSI (≥ 53), for the exploratory and confirmatory cohorts sensitivities were: 71–75%, 86–81%, 85–81%, and 71–69% and specificities were: 94–89%, 75–63%, 63–63%, and 75–88%, respectively. Higher cut-offs for CAP and biomarker scores may be better to diagnose moderate-to-severe steatosis in patients with morbid obesity.

scholarly journals Diagnostic accuracy and limitations of non-invasive tests in patients with metabolic-associated fatty liver disease

2021 ◽  
Vol 44 (5) ◽  
pp. 168-172
Author(s):  
Y Sánchez Torrijos ◽  
A Lucena Valera ◽  
J Ampuero Herrojo
Keyword(s):  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Fatty Liver Disease ◽  
Fibrosis Score ◽  
Non Invasive ◽  
Fatty Liver Index ◽  
Nafld Fibrosis Score ◽  
Hepatic Steatosis Index

Resumen La incidencia de la enfermedad del hígado graso asociada al metabolismo (MAFLD) ha aumentado en los últimos años debido al estilo de vida actual. La biopsia de hígado sigue siendo la herramienta estándar de oro para detectar y estadificar MAFLD. Por otro lado, se están desarrollando múltiples biomarcadores y pruebas no invasivas para superar las limitaciones de la biopsia hepática, incluidos el costo y la invasividad. Las pruebas no invasivas se centran principalmente en la esteatosis y, en particular, en la fibrosis hepática y se pueden clasificar en pruebas patentadas y no patentadas. Si bien hepatic steatosis index y fatty liver index son las pruebas más comunes utilizadas para la detección de esteatosis, Hepamet Fibrosis Score, NAFLD fibrosis score, FIB-4, OWLiver®, y ELF® son las más utilizadas para la fibrosis hepática. Sin embargo, las pruebas no invasivas también tienen limitaciones que conviene resaltar ya que sus resultados podrían verse afectados por la presencia de diabetes, obesidad o por edades extremas que podrían dar lugar a falsos positivos o negativos. Para maximizar la precisión de los tests no invasivos, se han propuesto diferentes combinaciones integradas en algoritmos escalonados. Esta revisión tiene como objetivo destacar las fortalezas y limitaciones de dichos tests para detectar y estadificar MAFLD.

scholarly journals Independent validation of the Enhanced Liver Fibrosis (ELF) score in the ANRS HC EP 23 Fibrostar cohort of patients with chronic hepatitis C

2012 ◽  
Vol 50 (4) ◽  
Author(s):  
Jérôme Guéchot ◽  
Candice Trocmé ◽  
Jean-Charles Renversez ◽  
Nathalie Sturm ◽  
Jean-Pierre Zarski
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Chronic Hepatitis C ◽  
Predictive Value ◽  
Roc Curves ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Significant Fibrosis ◽  
Health Authorities

Abstract: The Enhanced Liver Fibrosis (ELF) score combining serum hyaluronan, N-terminal peptide of type III procollagen and tissue inhibitor of metalloproteinase-1, was reported as relevant in predicting liver fibrosis in chronic liver disease and proposed as an alternative to liver biopsy.: We evaluated the ELF score in a cohort of chronic hepatitis C (CHC) patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using commercial reagents, different from those developed by the manufacturer of the Siemens ELF™ test.: In 512 CHC, the ELF score, using ROC curves, showed good predictive performances for severe fibrosis [AUROC=0.82; 95% confidence interval (CI) 0.78–0.86]and for cirrhosis (AUROC=0.85; 95% CI 0.81–0.90), but slightly lower for significant fibrosis (AUROC=0.78; 95% CI 0.74–0.82). The Obuchowski measure (0.81) showed that the ELF score globally performed as a marker of liver fibrosis. The ELF score predicted significant fibrosis (cut-off=9.0) with a sensitivity of 0.86, a specificity of 0.62, a positive predictive value (PPV) of 0.80 and a negative predictive value (NPV) of 0.70. For extensive fibrosis (cut-off=9.33), sensitivity was 0.90, specificity was 0.63, PPV was 0.73 and NPV was 0.85. For cirrhosis (cut-off=9.35), sensitivity was 0.83, specificity was 0.75, PPV was 0.44 and NPV was 0.95.: This study confirms the ELF score performance as an index to predict liver fibrosis or cirrhosis in CHC. The ELF test, using validated reagents, could be added to the health authorities approved non-invasive tests in assessing fibrosis as surrogate to liver biopsy.

scholarly journals FAT score: an Indian insight to a novel diagnostic score to differentiate non-alcoholic steatohepatitis (NASH) from simple steatosis

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Jijo Varghese ◽  
Anoop K V ◽  
Krishnadas Devadas ◽  
Tharun Tom
Keyword(s):  
Liver Biopsy ◽  
Univariate Analysis ◽  
Roc Curves ◽  
Predictive Score ◽  
Maximum Score ◽  
Cutoff Value ◽  
Simple Steatosis ◽  
Diagnostic Score ◽  
Study Population ◽  
Fat Score

Abstract Background The aim of this study was to propose a simple predictive score to differentiate NASH from simple steatosis. Results This study included 64 patients who had biopsy-proven NAFLD, of which 34 patients had steatohepatitis and 30 had simple steatosis. Clinical, anthropometric, and biochemical variables of the study population were analyzed. Univariate analysis showed platelet count, ferritin, and transaminases (ALT&AST) were predictors of NASH. This led to the proposal of a new diagnostic tool, FAT score (F signifies Ferritin, A indicates AST&ALT, T denotes t in Platelet) with AUROC of 0.95. The ROC curves for the significant variables were plotted and cutoff values were identified. Each component is awarded a score of 0 or 1, based on this cutoff value. The component is awarded a score of 1 if the component score is above the cutoff value and 0, if the score is below cutoff. The maximum score which can be obtained is 4. A score of ≥ 3 was able to predict NASH from simple steatosis with a sensitivity of 76.5% and a specificity of 100%. The score was validated with a cohort of 84 liver biopsy patients wherein a cutoff ≥ 3 was found to give a specificity of 100% in the validation cohort. Conclusions FAT score is a simple predictive model to differentiate NASH from simple steatosis (cutoff of more than or equal to 3) without performing a liver biopsy. A FAT score less than 3 rules out the need for biopsy.

The Relevance of Noninvasive Tools To Assess Fibrosis in Non-Alcoholic Fatty Liver Disease

2020 ◽  
Vol 26 (32) ◽  
pp. 3928-3938
Author(s):  
Grazia Pennisi ◽  
Ciro Celsa ◽  
Antonina Giammanco ◽  
Federica Spatola ◽  
Salvatore Petta
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Assessment Tools ◽  
Hepatic Decompensation ◽  
Alcoholic Fatty Liver ◽  
Simple Steatosis ◽  
Life Threatening ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver diseases worldwide, involving about 25% of people. NAFLD incorporates a large spectrum of pathological conditions, from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis and its complications include hepatic decompensation and hepatocellular carcinoma (HCC). This progression occurs, over many years, in an asymptomatic way, until advanced fibrosis appears. Thus, the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis are key issues. To date, the histological assessment of fibrosis with liver biopsy is the gold standard, but obviously, invasiveness is the greater threshold. In addition, rare but potentially life-threatening complications, poor acceptability, sampling variability and cost maybe restrict its use. Furthermore, due to the epidemic of NAFLD worldwide and several limitations of liver biopsy evaluation, noninvasive assessment tools to detect fibrosis in NAFLD patients are needed.

scholarly journals External Validation of Surrogate Indices of Fatty Liver in the General Population: The Bagnacavallo Study

2021 ◽  
Vol 10 (3) ◽  
pp. 520
Author(s):  
Francesco Foschi ◽  
Fabio Conti ◽  
Marco Domenicali ◽  
Pierluigi Giacomoni ◽  
Alberto Borghi ◽  
...  
Keyword(s):  
General Population ◽  
Fatty Liver ◽  
External Validation ◽  
Strongly Correlated ◽  
Alcoholic Fatty Liver ◽  
Fatty Liver Index ◽  
C Statistic ◽  
Hepatic Steatosis Index ◽  
The Town ◽  
Small Advantage

We externally validated the fatty liver index (FLI), the lipid accumulation product (LAP), the hepatic steatosis index (HSI), and the Zhejiang University index (ZJU) for the diagnosis of fatty liver (FL) and non-alcoholic fatty liver disease (NAFLD) in the general population. The validation was performed on 2159 citizens of the town of Bagnacavallo (Ravenna, Italy). Calibration was evaluated by calculating the calibration slope and intercept and by inspecting calibration plots; discrimination was evaluated using the c-statistic. The average calibration slope was 1 and the average intercept was 0 for all combinations of outcomes and indices. For the diagnosis of FL, the c-statistic was 0.85 for FLI, 0.83 for ZJU, 0.82 for HSI, and 0.80 for LAP; for the diagnosis of NAFLD, the c-statistic was 0.77 for FLI, 0.76 for ZJU, 0.75 for HSI, and 0.74 for LAP. All indices were strongly correlated with each other. In conclusion, FLI, LAP, HSI, and ZJU perform similarly well to diagnose FL and NAFLD in the Bagnacavallo population, even if FLI has a small advantage as discrimination is concerned.

scholarly journals Alanine Aminotransferase is a Predictor of NAFLD Activity Score for Diagnosing Non-alcoholic Steatoehpatitis

2019 ◽  
Vol 48 (2) ◽  
pp. 1-6
Author(s):  
Dulal Chandra Das ◽  
Sheikh Mohammad Noor E Alam ◽  
Ripon Das ◽  
Masuda Mohsena ◽  
Mamun Al Mahtab
Keyword(s):  
Liver Biopsy ◽  
Alanine Aminotransferase ◽  
Screening Tools ◽  
Activity Score ◽  
P Value ◽  
Simple Steatosis ◽  
Triglyceride Accumulation ◽  
Nash Group ◽  
Significant Difference ◽  
Nafld Activity Score

Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder characterized by excessive triglyceride- accumulation in hepatocytes. NAFLD has a multifactorial etiology and a combination of environmental, genetic and metabolic factors play a role in the development of advanced disease. NAFLD consists of a wide spectrum of conditions, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) which can progress to cirrhosis and hepatocellular carcinoma (HCC). Despite the high prevalence and severity of hepatic illness, NAFLD remains under diagnosed, because of few symptoms, lack of accurate laboratory markers. The accurate diagnosis of NASH remains dependent on specific histological parameters in liver biopsy. Although liver biopsy remains the ‘gold standard’, there are practical limitations, including costs and risks. There is an increasing requirement for simple, less invasive, highly accurate and affordable screening tools. Alanine aminotransferase (ALT) has been proposed as a noninvasive and available marker for assessment of NASH. A hospital based observational study was carried out for a period of two years in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were analyzed by SPSS version 16. Statistical inference were done by estimating distribution, Chi-square test and student’s t-test respectively. Fifty (50) patients were analysed.Twenty five were NASH and twenty five were simple steatosis. ALT in NASH group  were 97.0±51.5IU/L and insimple steatosis group were 55.5±28.6 IU/L. In NASH group 64%  of raised ALT had NASH . In Non-NASH group 16% of raised ALT had no NASH.There was significant difference in the NAFLD activity score for diagnosing NASH between elevated and normal ALT( P  value 0.001). Bangladesh Med J. 2019 May; 48 (2): 1-6

scholarly journals Does level of training Influence the ability to detect hepatosplenomegaly in children with leukemia?

2012 ◽  
Vol 3 (2) ◽  
pp. e146-e150
Author(s):  
Donna L Johnston ◽  
Janelle Cyr
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
First Year ◽  
Training Level ◽  
Pediatric Residents ◽  
The Past ◽  
Ultrasound Findings ◽  
Level Of Training ◽  
Better Than

Background: Children with leukemia often have hepatosplenomegaly present. This can be diagnosed with physical examination and confirmed with ultrasound. We sought to determine if level of training influenced the ability to detect hepatosplenomegaly. Methods: All children diagnosed with leukemia during the past 5 years were reviewed. The training level of the examiner, the documentation of hepatosplenomegaly, and the ultrasound findings were collected and analyzed. Results: There were 245 examinations of the spleen and 254 of the liver. Splenomegaly was correctly diagnosed by medical students 54% of the time, by residents 81%, and by staff 79% of the time. First year residents diagnosed it correctly 68% of the time, R2s 64%, R3s 76% and R4s 86% of the time. Hepatomegaly was correctly diagnosed by medical students 44% of the time, by residents 73% and by staff 68% of the time. First year residents diagnosed it correctly 77% of the time, R2s 54%, R3s 81% and R4s 75% of the time. Conclusions: Pediatric residents had the best ability to detect hepatosplenomegaly, and were better than staff and medical students, although this was not statistically significant.

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats

2018 ◽  
Vol 21 (6) ◽  
pp. 529-536 ◽  
Author(s):  
Michelle Pavlick ◽  
Cynthia RL Webster ◽  
Dominique G Penninck
Keyword(s):  
Liver Biopsy ◽  
Vitamin K ◽  
Major Bleeding ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
P Value ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Coagulation Parameters ◽  
Ultrasound Findings

Objectives Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. Methods The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >−6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher’s exact test, ANOVA and Pearson’s correlation coefficient, with a P value <0.05 considered significant. Results All cats had a decrease in PCV after biopsy. The mean ΔPCV was −6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. Conclusions and relevance PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

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