A sequential approach using the age-adjusted fibrosis-4 index and vibration-controlled transient elastography to detect advanced fibrosis in Korean patients with non-alcoholic fatty liver disease
Dong Hyeon Lee
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSe Un Sung
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorYun Kyu Lee
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorIk Hyeon Lim
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorHeejoon Jang
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSae Kyoung Joo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorJeong Hwan Park
Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorMee Soo Chang
Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorYoung Ho So
Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Won Kim
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Correspondence
Won Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea.
Email: [email protected]
Search for more papers by this authorthe Innovative Target Exploration of NAFLD (ITEN) Consortium
Search for more papers by this authorDong Hyeon Lee
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSe Un Sung
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorYun Kyu Lee
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorIk Hyeon Lim
Seoul National University College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorHeejoon Jang
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSae Kyoung Joo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorJeong Hwan Park
Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorMee Soo Chang
Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorYoung Ho So
Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Won Kim
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
Correspondence
Won Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea.
Email: [email protected]
Search for more papers by this authorthe Innovative Target Exploration of NAFLD (ITEN) Consortium
Search for more papers by this authorFunding information
This work was supported by a grant from the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (HI21C0538), National Research Foundation of Korea (NRF) grant funded by the Korean Government (NRF-2021R1A2C2005820 and NRF-2021M3A9E4021818), and Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (03-2019-8).
The Handling Editor for this article was Professor Grace Wong, and it was accepted for publication after full peer-review.
Summary
Background and Aims
Vibration-controlled transient elastography (VCTE) has shown good diagnostic performance in predicting fibrosis stages in patients with non-alcoholic fatty liver disease (NAFLD). However, an optimal diagnostic approach to detect advanced fibrosis in patients with NAFLD has not been established.
Approach and Results
We prospectively collected data from 539 subjects who underwent liver biopsy at a single centre between January 2014 and December 2019. Diagnostic performance was estimated using the area under the receiver-operating characteristic curve (AUROC). Several models combining the fibrosis 4 index (FIB-4) score and liver stiffness measurement (LSM) were analysed to reduce the need for unnecessary liver biopsies. We observed significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) in 173 (32.1%), 74 (13.7%) and 46 subjects (8.5%), respectively. The AUROCs (95% CI) for LSMs to diagnose ≥F2, ≥F3 and F4 were 0.82 (0.78-0.85), 0.92 (0.89-0.94) and 0.95 (0.93-0.97), respectively. Optimal LSM cut-off values were 6.7 (≥F2), 8.3 (≥F3) and 9.8 (F4) kPa. LSMs were affected by waist circumference, serum albumin and fibrosis stage (R2 = 0.315). Abdominal obesity, elevated transaminase, diabetes mellitus and high IQR/Median were associated with the discordance of ≥2 fibrosis stages between LSMs and histologic data. The sequential use of the age-adjusted FIB-4 and LSMs yielded the least uncertainty (5.3%) in classifying disease severity with the highest diagnostic accuracy (81%) among a variety of non-invasive test combinations.
Conclusions
The sequential approach of age-adjusted FIB-4 and VCTE could represent a practical diagnostic strategy to detect advanced fibrosis in NAFLD (ClinicalTrials.gov #NCT 02206841).
Open Research
DATA AVAILABILITY STATEMENT
Research data are not shared.
Supporting Information
| Filename | Description |
|---|---|
| apt16766-sup-0001-Supinfo.docxWord 2007 document , 46.3 KB | Supplementary Material |
| apt16766-sup-0002-FigS1.tifTIFF image, 1.9 MB | Fig S1 |
| apt16766-sup-0003-FigS2.tifTIFF image, 1.8 MB | Fig S2 |
| apt16766-sup-0004-FigS3.tifTIFF image, 1.6 MB | Fig S3 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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