@article{3031920,
    title = "Long-term outcomes and predictive ability of non-invasive scoring
systems in patients with non-alcoholic fatty liver disease",
    author = "Younes, Ramy and Caviglia, Gian Paolo and Younes, Ramy and Caviglia, and Gian Paolo and Govaere, Olivier and Rosso, Chiara and Armandi, Angelo and and Sanavia, Tiziana and Pennisi, Grazia and Liguori, Antonio and and Francione, Paolo and Gallego-Duran, Rocio and Ampuero, Javier and and Blanco, Maria J. Garcia and Aller, Rocio and Tiniakos, Dina and Burt, and Alastair and David, Ezio and Vecchio, Fabio M. and Maggioni, Marco and and Cabibi, Daniela and Pareja, Maria Jesus and Zaki, Marco Y. W. and and Grieco, Antonio and Fracanzani, Anna L. and Valenti, Luca and Miele, and Luca and Fariselli, Piero and Petta, Salvatore and Romero-Gomez, Manuel and and Anstee, Quentin M. and Bugianesi, Elisabetta",
    journal = "Korean Journal of Hepatology",
    year = "2021",
    volume = "75",
    number = "4",
    pages = "786-794",
    publisher = "Elsevier",
    doi = "10.1016/j.jhep.2021.05.008",
    keywords = "NASH; NSS; APRI; BARD; FIB-4; NFS; HFS",
    abstract = "Background & Aims: Non-invasive scoring systems (NSS) are used to
identify patients with non-alcoholic fatty liver disease (NAFLD) who are
at risk of advanced fibrosis, but their reliability in predicting
long-term outcomes for hepatic/extrahepatic complications or death and
their concordance in cross-sectional and longitudinal risk
stratification remain uncertain.
Methods: The most common NSS (NFS, FIB-4, BARD, APRI) and the Hepamet
fibrosis score (HFS) were assessed in 1,173 European patients with NAFLD
from tertiary centres. Performance for fibrosis risk stratification and
for the prediction of long-term hepatic/extrahepatic events,
hepatocarcinoma (HCC) and overall mortality were evaluated in terms of
AUC and Harrell’s c-index. For longitudinal data, NSS-based Cox
proportional hazard models were trained on the whole cohort with
repeated 5-fold cross-validation, sampling for testing from the 607
patients with all NSS available.
Results: Cross-sectional analysis revealed HFS as the best performer for
the identification of significant (F0-1 vs. F2-4, AUC = 0.758) and
advanced (F0-2 vs. F3-4, AUC = 0.805) fibrosis, while NFS and FIB-4
showed the best performance for detecting histological cirrhosis (range
AUCs 0.85-0.88). Considering longitudinal data (follow-up between 62 and
110 months), NFS and FIB-4 were the best at predicting liver-related
events (c-indices>0.7), NFS for HCC (c-index = 0.9 on average), and
FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed
limited performance (c-indices <0.7) for extrahepatic events.
Conclusions: Overall, NFS, HFS and FIB-4 outperformed APRI and BARD for
both cross-sectional identification of fibrosis and prediction of
long-term outcomes, confirming that they are useful tools for the
clinical management of patients with NAFLD at increased risk of fibrosis
and liver-related complications or death.
Lay summary: Non-invasive scoring systems are increasingly being used in
patients with non-alcoholic fatty liver disease to identify those at
risk of advanced fibrosis and hence clinical complications. Herein, we
compared various non-invasive scoring systems and identified those that
were best at identifying risk, as well as those that were best for the
prediction of long-term outcomes, such as liver-related events, liver
cancer and death. (C) 2021 European Association for the Study of the
Liver. Published by Elsevier B.V. All rights reserved."
}