Performance of Noninvasive Liver Fibrosis Scores in the Morbid Obese Patient, Same Scores but Different Thresholds
| Autor: | Diego Meneses, Lucrecia Herranz, Miriam Romero, Isabel Calvo-Viñuelas, María del Carmen Méndez, Ramón Corripio, Antonio Olveira, Ana Isabel de-Cos-Blanco, David Vicent |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Liver Cirrhosis
medicine.medical_specialty Biopsy Endocrinology Diabetes and Metabolism Aspartate transaminase 030209 endocrinology & metabolism Logistic regression Chronic liver disease Gastroenterology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Non-alcoholic Fatty Liver Disease Fibrosis Internal medicine Nonalcoholic fatty liver disease Humans Medicine Nutrition and Dietetics Receiver operating characteristic medicine.diagnostic_test biology business.industry Alanine Transaminase medicine.disease Obesity Morbid Cross-Sectional Studies Liver ROC Curve chemistry Liver biopsy biology.protein 030211 gastroenterology & hepatology Surgery Glycated hemoglobin business Biomarkers |
| Zdroj: | Obesity Surgery. 30:2538-2546 |
| ISSN: | 1708-0428 0960-8923 |
| Popis: | Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. It is a spectrum of progressive alterations, with the final step in liver fibrosis which carries a high burden of long-term mortality. The scores used to predict liver fibrosis are not properly validated in morbid obesity (MO). Our aim was to evaluate the performance of seven risk scores in bariatric surgery (BS) patients. Cross-sectional analysis in a cohort of 60 patients with MO undergoing BS. Liver biopsy (LB) was taken and compared with fibrosis risk assessed by noninvasive scores: APRI, FIB-4, Forns, NFS (NAFLD fibrosis score), BARD, BAAT, and Hepamet. The area under the receiver operator characteristic curve (AUROC) and measures of diagnostic accuracy were calculated; performance of fibrosis scores was evaluated at standard threshold vs those suggested by ROC analysis. LB was available in 50 patients; 9 (18%) had significant fibrosis (F2-F4). The BARD and Forns scores best predicted the absence of fibrosis, both with negative predictive value (NPV) of 95.5%, with AUROC of 0.761 and 0.667, respectively. Modification of standard thresholds (2 for BARD and 6.9 for Forns) to those suggested by ROC analysis (3 and 3.6, respectively) improved performance of scores. Basal glucose, glycated hemoglobin (HbA1c), aspartate transaminase (AST), and gamma glutamyl transferase (GGT) were identified by logistic regression analysis as independent predictor of fibrosis. Existing scoring systems are unable to stratify fibrosis risk in MO using established thresholds; its performance is improved if these cutoffs are modified. |
| Databáze: | OpenAIRE |
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