Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes

Pennisi, Grazia; Enea, Marco; Falco, Vincenzo; Aithal, Guruprasad P.; Palaniyappan, Naaventhan; Yilmaz, Yusuf; Boursier, Jerome; Cassinotto, Christophe; de Lédinghen, Victor; Chan, Wah Kheong; Mahadeva, Sanjiv; Eddowes, Peter; Newsome, Philip; Karlas, Thomas; Wiegand, Johannes; Wong, Vincent Wai-Sun; Schattenberg, Jörn M; Labenz, Christian; Kim, Won; Lee, Myoung Seok; Lupsor-Platon, Monica; Cobbold, Jeremy F L; Fan, Jian-Gao; Shen, Feng; Staufer, Katharina; Trauner, Michael; Stauber, Rudolf; Nakajima, Atsushi; Yoneda, Masato; Bugianesi, Elisabetta; Younes, Ramy; Gaia, Silvia; Zheng, Ming-Hua; Cammà, Calogero; Anstee, Quentin M; Mózes, Ferenc Emil; Pavlides, Michael; Petta, Salvatore

Abstract

Background and Aims: We evaluated the diagnostic accuracy of simple, noninvasive tests (NITs) in NAFLD patients with type 2 diabetes (T2D). Methods and Results: This was an individual patient data meta-analysis of 1780 patients with biopsy-proven NAFLD and T2D. The index tests of interest were FIB-4, NAFLD Fibrosis Score (NFS), aspartate aminotransferase-to-platelet ratio index, liver stiffness measurement (LSM) by vibration-controlled transient elastography, and AGILE 3+. The target conditions were advanced fibrosis, NASH, and fibrotic NASH(NASH plus F2-F4 fibrosis). The diagnostic performance of noninvasive tests. individually or in sequential combination, was assessed by area under the receiver operating characteristic curve and by decision curve analysis. Comparison with 2278 NAFLD patients without T2D was also made. In NAFLD with T2D LSM and AGILE 3+ outperformed, both NFS and FIB-4 for advanced fibrosis (area under the receiver operating characteristic curve:LSM 0.82, AGILE 3+ 0.82, NFS 0.72, FIB-4 0.75, aspartate aminotransferase-to-platelet ratio index 0.68; p < 0.001 of LSM-based versus simple serum tests), with an uncertainty area of 12%-20%. The combination of serum-based with LSM-based tests for advanced fibrosis led to a reduction of 40%-60% in necessary LSM tests. Decision curve analysis showed that all scores had a modest net benefit for ruling out advanced fibrosis at the risk threshold of 5%-10% of missing advanced fibrosis. LSM and AGILE 3+ outperformed both NFS and FIB-4 for fibrotic NASH (area under the receiver operating characteristic curve:LSM 0.79, AGILE 3+ 0.77, NFS 0.71, FIB-4 0.71; p < 0.001 of LSM-based versus simple serum tests). All noninvasive scores were suboptimal for diagnosing NASH. Conclusions: LSM and AGILE 3+ individually or in low availability settings in sequential combination after FIB-4 or NFS have a similar good diagnostic accuracy for advanced fibrosis and an acceptable diagnostic accuracy for fibrotic NASH in NAFLD patients with T2D.

Citation

Pennisi, G., Enea, M., Falco, V., Aithal, G. P., Palaniyappan, N., Yilmaz, Y., Boursier, J., Cassinotto, C., de Lédinghen, V., Chan, W. K., Mahadeva, S., Eddowes, P., Newsome, P., Karlas, T., Wiegand, J., Wong, V. W.-S., Schattenberg, J. M., Labenz, C., Kim, W., Lee, M. S., …Petta, S. (2023). Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes. Hepatology, 78(1), 195-211. https://doi.org/10.1097/HEP.0000000000000351

• Journal Article Type: Article
• Acceptance Date: Jan 4, 2023
• Online Publication Date: Mar 17, 2023
• Publication Date: 2023-07
• Deposit Date: Jul 19, 2023
• Publicly Available Date: Mar 18, 2024
• Journal: Hepatology
• Print ISSN: 0270-9139
• Electronic ISSN: 1527-3350
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 78
• Issue: 1
• Pages: 195-211
• DOI: https://doi.org/10.1097/HEP.0000000000000351
• Keywords: Hepatology
• Public URL: https://nottingham-repository.worktribe.com/output/19287067
• Publisher URL: https://journals.lww.com/hep/Abstract/2023/07000/Noninvasive_assessment_of_liver_disease_severity.17.aspx
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Hepatology. The published version of record Pennisi, G., Enea, M., Falco, V., Aithal, G. P., Palaniyappan, N., Yilmaz, Y., …Petta, S. (2023). Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes. Hepatology, 78(1), 195-211 is available online at: https://doi.org/10.1097/HEP.0000000000000351