Abstract
BackgroundSeveral non-invasive prediction scores for non-alcoholic fatty liver disease (NAFLD) have been developed, but their performance has not been compared and validated in the same population, and whether these prediction scores can predict clinical outcomes remains unknown. In this study, we aimed to validate and compare the performance of four NAFLD prediction scores: fatty liver index, hepatic steatosis index, lipid accumulation product, and NAFLD liver fat score (LFS), and to evaluate the ability of the best NAFLD prediction score to predict mortality.MethodsWe analyzed data from the National Health and Nutrition Examination Survey conducted in 1988 to 1994, and subsequent follow-up data for mortality up to December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases.ResultsIn a group of 5,184 participants, LFS consistently showed the highest area under the curve for predicting the presence of NAFLD. During a median follow-up of 14.7 years (range 0.1 to 18.2 years) and 83,830.5 person-years, participants in the high LFS group (LFS ≥1.257) had a higher cardiovascular and liver-related mortality than participants in the low (LFS ≤ −1.413; cardiovascular hazard ratio (HR) = 2.24, 95% CI 1.03 to 4.88; liver HR = 31.25, 95% CI 3.13 to 333.33) or intermediate (−1.413 < LFS < 1.257; cardiovascular HR = 2.3, 95% CI 1.19 to 4.48; liver HR = 30.3, 95% CI 4 to 250) LFS groups in the fully adjusted model. Similar results were obtained when LFS was treated as a continuous variable.ConclusionsLFS is the best non-invasive prediction score for NAFLD, and people with a high LFS score have an increased risk for cardiovascular and liver-related mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0154-x) contains supplementary material, which is available to authorized users.
Highlights
Several non-invasive prediction scores for non-alcoholic fatty liver disease (NAFLD) have been developed, but their performance has not been compared and validated in the same population, and whether these prediction scores can predict clinical outcomes remains unknown
NAFLD is regarded as a hepatic manifestation of metabolic syndrome (MetS) [1], the presence of NAFLD is strongly associated with liver-related mortality, and with diseases related to the MetS, such as diabetes and cardiovascular diseases [2,3]
For NAFLD prediction, liver fat score (LFS) was the best performer for predicting NAFLD, with an area under curve (AUC) of 0.771 (P < 0.001), whereas the lowest AUC (0.732) was observed for hepatic steatosis index (HSI) (Table 2)
Summary
Several non-invasive prediction scores for non-alcoholic fatty liver disease (NAFLD) have been developed, but their performance has not been compared and validated in the same population, and whether these prediction scores can predict clinical outcomes remains unknown. Five biomarkerbased non-invasive prediction scores of NAFLD have been developed: SteatoTest [5], fatty liver index (FLI) [6], NAFLD liver fat score (LFS) [7], lipid accumulation product (LAP) [8], and hepatic steatosis index (HSI) [9] These scores are derived from simple clinical risk factors and biomarkers, and can potentially be used for large-scale NAFLD screening. Different definitions and techniques were used to define NAFLD in the original studies, and the performances of these scores have not been validated, evaluated, and compared directly in a large general population Whether these non-invasive scores of NAFLD can predict clinical outcome remains largely unknown
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