Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease

NASH Clinical Research Network

Research output: Contribution to journalArticle

358 Citations (Scopus)

Abstract

BACKGROUND & AIMS: There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD. METHODS: Using a nation-wide database of 541 adults with NAFLD, jackknifevalidated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. RESULTS: The median FIB4 score was 1.11 (interquartile range = 0.74 -1.67). The jackknifevalidated AUROC for FIB4 was 0.802 (95% confidence interval [CI], 0.758 - 0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95% CI, 0.720 - 0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95% CI, 0.695- 0.791; P < .01), AST:ALT ratio (0.742; 95% CI, 0.690 - 0.794; P < .015), AST:platelet ratio index (0.730; 95% CI, 0.681- 0.779; P < .001), AST:platelet ratio (0.720; 95% CI, 0.669 - 0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95% CI, 0.614 - 0.718; P < .001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50% (95% CI, 46-55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≥ 1.30 had a 90% negative predictive value. CONCLUSIONS: The FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.

Original languageEnglish (US)
Pages (from-to)1104-1112
Number of pages9
JournalClinical Gastroenterology and Hepatology
Volume7
Issue number10
DOIs
StatePublished - Oct 1 2009

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Fibrosis
Confidence Intervals
Aspartate Aminotransferases
Alanine Transaminase
ROC Curve
Blood Platelets
Non-alcoholic Fatty Liver Disease
Platelet Count
Liver Cirrhosis
Body Mass Index
Databases
Liver

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. / NASH Clinical Research Network.

In: Clinical Gastroenterology and Hepatology, Vol. 7, No. 10, 01.10.2009, p. 1104-1112.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND & AIMS: There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD. METHODS: Using a nation-wide database of 541 adults with NAFLD, jackknifevalidated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90{\%} specificity, 80{\%} positive predictive value, and 90{\%} negative predictive values were determined along with cutoffs for advanced fibrosis. RESULTS: The median FIB4 score was 1.11 (interquartile range = 0.74 -1.67). The jackknifevalidated AUROC for FIB4 was 0.802 (95{\%} confidence interval [CI], 0.758 - 0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95{\%} CI, 0.720 - 0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95{\%} CI, 0.695- 0.791; P < .01), AST:ALT ratio (0.742; 95{\%} CI, 0.690 - 0.794; P < .015), AST:platelet ratio index (0.730; 95{\%} CI, 0.681- 0.779; P < .001), AST:platelet ratio (0.720; 95{\%} CI, 0.669 - 0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95{\%} CI, 0.614 - 0.718; P < .001). For a fixed specificity of 90{\%} (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50{\%} (95{\%} CI, 46-55). A FIB4 ≥ 2.67 had an 80{\%} positive predictive value and a FIB4 index ≥ 1.30 had a 90{\%} negative predictive value. CONCLUSIONS: The FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.",
author = "{NASH Clinical Research Network} and Shah, {Amy G.} and Alison Lydecker and Karen Murray and Tetri, {Brent N.} and Contos, {Melissa J.} and Sanyal, {Arun J.} and Stephanie Abrams and Diana Arceo and Denise Espinosa and Leanel Fairly and Arthur McCullough and Diane Bringman and Srinivasan Dasarathy and Carol Hawkins and Liu, {Yao Chang} and Nicholette Rogers and Margaret Stager and Kevin Edwards and Ruth Sargent and Melissa Coffey and Melissa Young and Parvathi Mohan and Kavita Nair and Manal Abdelmalek and Diehl, {Anna Mae} and Marcia Gottfried and Cynthia Guy and Paul Killenberg and Samantha Kwan and Pan, {Yi Ping} and Dawn Piercy and Melissa Smith and Prajakta Bhimalli and Naga Chalasani and Oscar Cummings and Lydia Lee and Linda Ragozzino and Raj Vuppalanchi and Ann Scheimann and Michael Torbenson and Ann Klipsch and Jean Molleston and Girish Subbarao and Sarah Barlow and Jose Derdoy and Joyce Hoffmann and Debra King and Joan Siegner and Susan Stewart and Tetri, {Brent A.}",
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TY - JOUR

T1 - Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease

AU - NASH Clinical Research Network

AU - Shah, Amy G.

AU - Lydecker, Alison

AU - Murray, Karen

AU - Tetri, Brent N.

AU - Contos, Melissa J.

AU - Sanyal, Arun J.

AU - Abrams, Stephanie

AU - Arceo, Diana

AU - Espinosa, Denise

AU - Fairly, Leanel

AU - McCullough, Arthur

AU - Bringman, Diane

AU - Dasarathy, Srinivasan

AU - Hawkins, Carol

AU - Liu, Yao Chang

AU - Rogers, Nicholette

AU - Stager, Margaret

AU - Edwards, Kevin

AU - Sargent, Ruth

AU - Coffey, Melissa

AU - Young, Melissa

AU - Mohan, Parvathi

AU - Nair, Kavita

AU - Abdelmalek, Manal

AU - Diehl, Anna Mae

AU - Gottfried, Marcia

AU - Guy, Cynthia

AU - Killenberg, Paul

AU - Kwan, Samantha

AU - Pan, Yi Ping

AU - Piercy, Dawn

AU - Smith, Melissa

AU - Bhimalli, Prajakta

AU - Chalasani, Naga

AU - Cummings, Oscar

AU - Lee, Lydia

AU - Ragozzino, Linda

AU - Vuppalanchi, Raj

AU - Scheimann, Ann

AU - Torbenson, Michael

AU - Klipsch, Ann

AU - Molleston, Jean

AU - Subbarao, Girish

AU - Barlow, Sarah

AU - Derdoy, Jose

AU - Hoffmann, Joyce

AU - King, Debra

AU - Siegner, Joan

AU - Stewart, Susan

AU - Tetri, Brent A.

PY - 2009/10/1

Y1 - 2009/10/1

N2 - BACKGROUND & AIMS: There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD. METHODS: Using a nation-wide database of 541 adults with NAFLD, jackknifevalidated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. RESULTS: The median FIB4 score was 1.11 (interquartile range = 0.74 -1.67). The jackknifevalidated AUROC for FIB4 was 0.802 (95% confidence interval [CI], 0.758 - 0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95% CI, 0.720 - 0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95% CI, 0.695- 0.791; P < .01), AST:ALT ratio (0.742; 95% CI, 0.690 - 0.794; P < .015), AST:platelet ratio index (0.730; 95% CI, 0.681- 0.779; P < .001), AST:platelet ratio (0.720; 95% CI, 0.669 - 0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95% CI, 0.614 - 0.718; P < .001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50% (95% CI, 46-55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≥ 1.30 had a 90% negative predictive value. CONCLUSIONS: The FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.

AB - BACKGROUND & AIMS: There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD. METHODS: Using a nation-wide database of 541 adults with NAFLD, jackknifevalidated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. RESULTS: The median FIB4 score was 1.11 (interquartile range = 0.74 -1.67). The jackknifevalidated AUROC for FIB4 was 0.802 (95% confidence interval [CI], 0.758 - 0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95% CI, 0.720 - 0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95% CI, 0.695- 0.791; P < .01), AST:ALT ratio (0.742; 95% CI, 0.690 - 0.794; P < .015), AST:platelet ratio index (0.730; 95% CI, 0.681- 0.779; P < .001), AST:platelet ratio (0.720; 95% CI, 0.669 - 0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95% CI, 0.614 - 0.718; P < .001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50% (95% CI, 46-55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≥ 1.30 had a 90% negative predictive value. CONCLUSIONS: The FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.

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