BACKGROUND: Blood tests of liver injury are less well validated in non-alcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We pre-included new NAFLD patients with biopsy and blood tests from a single-centre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinary-ROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864-0.892) for FibroTest and fibrosis stages, 0.846 (0.830-0.862) for ActiTest and activity grades, and 0.822 (0.804-0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820-0.852; P = 0.0001), FIB4 (0.845; 0.829-0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850-0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are non-invasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis.
Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference / Munteanu, M.; Tiniakos, D.; Anstee, Q.; Charlotte, F.; Marchesini, G.; Bugianesi, E.; Trauner, M.; Romero Gomez, M.; Oliveira, C.; Day, C.; Dufour, J.-F.; Bellentani, S.; Ngo, Y.; Traussnig, S.; Perazzo, H.; Deckmyn, O.; Bedossa, P.; Ratziu, V.; Poynard, Thierry; Ratziu, Vlad; Castille, Jean-Marie; Ngo, Yen; Langon, Tania; Day, Chris; Tiniakos, Dina; Lawlor, Debbie; Marchesini, Giulio; Marra, Fabio; Bugianesi, Elisabetta; Bellentani, Stefano; Dufour, Jean-François; Romero Gomez, Manuel; Sørensen, Thorkild; Tribelli, Claudio; De Minicis, Samuele; Trauner, Michael; Oliveira, Claudia; Bedossa, Pierre; Burt, Alastair D.; Gouw, Annette S.H.; Lackner, Carolin; Schirmacher, Peter; Terracciano, Luigi; Tiniakos, Dina; Brain, J.; Bury, Yvonne; Cabibi, Daniela; Charlotte, Frederic; David, Ezio; Losi, Luisa; Montani, Matteo; Pareja, Marıa Jesus; Wendum, Dominique; Wrba, Fritz; Ziol, Marianne; Ratziu, Vlad; Ratziu, Vlad; Thabut, Dominique; Moussalli, Joseph; Lebray, Pascal; Rudler, Marika; Bismuth, Françoise Imbert; Charlotte, Frederic; Rosmorduc, Olivier; Calmus, Yvon; Hartemann, Agnes; Jacqueminet, Sophie; Bruckert, Eric; Giral, Philippe; Naveau, Sylvie; Perlemuter, Gabriel; Varsat, Brigitte; Mercadier, Anne. - In: ALIMENTARY PHARMACOLOGY & THERAPEUTICS. - ISSN 0269-2813. - STAMPA. - 44:(2016), pp. 877-889. [10.1111/apt.13770]
Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference
MARRA, FABIO;
2016
Abstract
BACKGROUND: Blood tests of liver injury are less well validated in non-alcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We pre-included new NAFLD patients with biopsy and blood tests from a single-centre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinary-ROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864-0.892) for FibroTest and fibrosis stages, 0.846 (0.830-0.862) for ActiTest and activity grades, and 0.822 (0.804-0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820-0.852; P = 0.0001), FIB4 (0.845; 0.829-0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850-0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are non-invasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis.
I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
