Advanced Fibrosis In Patients Research Articles

Proposal of a Novel Serological Algorithm Combining FIB-4 and Serum M2BPGi for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease.

Noninvasive methods have become increasingly critical in the diagnosis of fibrosis in chronic liver diseases. Herein, we compared the diagnostic performance of serum Mac2 binding protein glycosylation isomer (M2BPGi) and other serological panels for fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and proposed an improved two-step diagnostic algorithm for advanced fibrosis. We enrolled 231 patients diagnosed with NAFLD who underwent a liver biopsy. We subsequently evaluated the diagnostic performance of serological panels, including serum M2BPGi, a fibrosis index based on four factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), in predicting the stage of liver fibrosis. We then constructed a two-step algorithm to better differentiate advanced fibrosis. The areas under the receiver operating characteristic curves of serum M2BPGi, FIB-4, APRI, and NFS for advanced fibrosis (≥F3) were 0.823, 0.858, 0.779, and 0.827, respectively. To reduce the performance of unnecessary liver biopsy, we propose a two-step algorithm using FIB-4 as an initial diagnostic tool and serum M2BPGi (≥0.6) as an additional diagnostic method for patients classified as intermediate (23%). Using the proposed algorithm, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.812, 0.814, 0.814, 0.600, and 0.927, respectively. Serum M2BPGi is a simple and effective test for advanced fibrosis in patients with NAFLD. Application of the two-step algorithm based on FIB-4 and M2BPGi proposed here can improve diagnostic performance and reduce unnecessary tests, making diagnosis easily accessible, especially in primary medical centers.

SAT-440 - Head-to-head comparison of Agile 3+, LSM-VCTE, NFS, and FIB-4 scores for detecting advanced fibrosis in patients with type 2 diabetes seen in diabetes clinic

SAT-440 - Head-to-head comparison of Agile 3+, LSM-VCTE, NFS, and FIB-4 scores for detecting advanced fibrosis in patients with type 2 diabetes seen in diabetes clinic

SAT-469 - A sequential use of transient elastography followed by Agile 3+ score significantly improves the screening of advanced fibrosis in patients with NAFLD with or without severe obesity

SAT-469 - A sequential use of transient elastography followed by Agile 3+ score significantly improves the screening of advanced fibrosis in patients with NAFLD with or without severe obesity

SAT-472 - Analysis of the diagnostic accuracy of the non-invasive fibrosis indices NFS, HFS, and FIB-4 in the staging of advanced fibrosis in patients with metabolic fatty liver: meta-analysis of comparative studies

SAT-472 - Analysis of the diagnostic accuracy of the non-invasive fibrosis indices NFS, HFS, and FIB-4 in the staging of advanced fibrosis in patients with metabolic fatty liver: meta-analysis of comparative studies

WED-291 - Anti-Saccharomyces cerevisiae antibodies predict severe liver disease and advanced fibrosis in patients with primary sclerosing cholangitis and inflammatory bowel disease

WED-291 - Anti-Saccharomyces cerevisiae antibodies predict severe liver disease and advanced fibrosis in patients with primary sclerosing cholangitis and inflammatory bowel disease

Systemic Inflammatory Molecules Are Associated with Advanced Fibrosis in Patients from Brazil Infected with Hepatitis Delta Virus Genotype 3 (HDV-3).

Hepatitis Delta virus (HDV) genotype 3 is responsible for outbreaks of fulminant hepatitis in Northeastern South America. This study investigates if systemic inflammatory molecules are differentially expressed in patients with advanced fibrosis chronically infected with Hepatitis Delta virusgenotype 3(HDV-3). Sixty-one patients from the north of Brazil coinfected with hepatitis B virus (HBV)/HDV-3 were analyzed. HDV quantification and genotyping were performed by semi-nested real-time polymerase chain reaction (RT-PCR) and restriction fragment length polymorphism (RFLP) methodologies. Ninety-two systemic inflammatory molecules (SIMs) were measured by Proximity Extension Assay (PEA) technology. The Shapiro-Wilk, Student's t-test, Mann-Whitney tests, and logistic regression analysis were used when appropriate. The median age was 41 years, and all patients were HBeAg negative. Advanced fibrosis or cirrhosis was diagnosed by histological staging in 17 patients, while 44 presented with minimal or no fibrosis. Advanced necroinflammatory activity correlated positively with serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Established non-invasive fibrosis scores (APRI, FIB-4, and AST/ALT ratio) revealed low sensitivities and positive predictive values (PPVs) with an AUROC maximum of 0.586. Among the 92 SIMs analyzed, MCP.4, CCL19, EN.RAGE, SCF, and IL18 showed a positive correlation with fibrosis stage. A combined score including CCL19 and MCP.4 revealed a sensitivity of 81% and an odds ratio of 2.202 for advanced fibrosis. Standard non-invasive fibrosis scores showed poor performance in HDV-3 infection. We here suggest that the determination of CCL19 and MCP.4 may be used to identify patients with advanced fibrosis. Moreover, this study gives novel insights into the immunopathogenesis of HDV-3 infection.

Factors Associated with Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Introduction. Nonalcoholic fatty liver disease includes conditions such as nonalcoholic steatosis and nonalcoholic steatohepatitis, with varying degrees of fibrosis that can progress to cirrhosis and hepatocellular carcinoma. Although the gold standard for its diagnosis remains liver biopsy, many non-invasive methods have been proposed to aid in both the diagnosis of the disease and the evaluation of the presence of liver fibrosis, which is a strong and independent factor for liver related mortality. Objectives. The objectives of this study were: 1) to identify the clinical and laboratory features associated with the presence of advanced fibrosis in individuals with biopsy-confirmed nonalcoholic fatty liver disease; 2) to evaluate the performance of non-invasive markers in identifying patients with advanced fibrosis. Methods. A cross-sectional-analytic study that evaluated patients with nonalcoholic fatty liver disease treated in the outpatient clinic of a university hospital of reference in hepatology, between January 2013 and December 2016. Results. 81 patients aged 53.3 ± 9.8 years were included in this study; 39.5% were men and 70.1% were obese. When comparing patients with advanced fibrosis to those without advanced fibrosis, patients with advanced fibrosis had a lower proportion of males than females (17.6 vs. 45.4%, p = 0.038), a higher proportion of hypothyroidism (29.4 vs. 6.3%, p = 0.017) and a higher median AST (52 vs. 31 U/L, p = 0.005). In logistic regression analysis, only hypothyroidism was independently associated with advanced fibrosis (OR = 4.975; CI 95% 1.050 - 23.574; p = 0.043). Spearman correlation analysis showed that higher levels of fibrosis on liver biopsy, were associated with higher levels of TSH (r = 0.304; p = 0.036), AST (r = 0.277; p = 0.019), GGT (r = 0.284; p = 0.017) and LDL (r = 0.258; p = 0.037). Regarding the performance of the non-invasive markers, the area under the ROC curve of Fibrosis 4 score was 0.723 (p = 0.008), that of Nonalcoholic fatty liver disease fibrosis score was 0.713 (p = 0.022), that of gamma-glutamyl transferase platelet ratio was 0.697 (p = 0.019) and that of aspartate-to-alanine aminotransferase ratio was 0.689 (p = 0.031). Conclusions. Hypothyroidism is a factor independently associated with advanced fibrosis. In the outpatient setting, non-invasive markers may be useful in identifying patients with advanced fibrosis.

Comparative Accuracy of Clinical Fibrosis Markers, Hepascore and Fibroscan® to Detect Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

BackgroundNon-invasive tests are widely used to diagnose fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), however, the optimal method remains unclear. We compared the accuracy of simple serum models, a serum model incorporating direct measures of fibrogenesis (Hepascore), and Fibroscan®, for detecting fibrosis in NAFLD.MethodsNAFLD patients undergoing liver biopsy were evaluated with Hepascore, NAFLD Fibrosis Score (NFS), FIB-4 and AST-platelet ratio index (APRI), with a subset (n = 131) undergoing Fibroscan®. Fibrosis on liver biopsy was categorized as advanced (F3–4) or cirrhosis (F4). Accuracy was determined by area under receiving operating characteristic curves (AUC). Indeterminate ranges were calculated using published cut-offs.ResultsIn 271 NAFLD patients, 83 (31%) had F3–4 and 47 (17%) cirrhosis. 6/131 (4%) had an unreliable Fibroscan®. For the detection of advanced fibrosis, the accuracy of Hepascore (AUC 0.88) was higher than FIB-4 (0.73), NFS (0.72) and APRI (0.69) (p < 0.001 for all). Hepascore had similar accuracy to Fibroscan® (0.80) overall, but higher accuracy in obese individuals (0.91 vs 0.80, p = 0.001). Hepascore more accurately identified patients with cirrhosis than APRI (AUC 0.85 vs 0.71, p = 0.01) and NFS (AUC 0.73, p = 0.01) but performed similar to FIB-4 and Fibroscan®. For the determination of F3-4, the proportion of patients in indeterminate area was lower for Hepascore (4.8%), compared to FIB-4 (42%), NFS (36%) and APRI (44%) (p < 0.001 for all).ConclusionsHepascore has greater accuracy and a lower indeterminate range than simple serum fibrosis tests for advanced fibrosis in NAFLD, and greater accuracy than Fibroscan® in obese individuals.

The utility of non-invasive tests to assess advanced fibrosis in Asian subjects with chronic hepatitis B and concomitant hepatic steatosis.

Chronic hepatitis B (CHB) is endemic to Asia and is a leading cause of liver-related morbidity. The prevalence of concomitant CHB and hepatic steatosis (HS) is increasing in Asia. Non-invasive tests (NITs) including FIB-4, NFS and APRI assess fibrosis in populations with a single aetiology, but not in subjects with concomitant CHB and HS. To explore the accuracy of NITs in predicting advanced fibrosis in patients with concomitant CHB and HS. This multicentre study of CHB patients who underwent liver biopsy explored clinical characteristics of these subjects, stratified by presence of HS. Fibrosis scores from NITs were compared against histological fibrosis stage in CHB subjects with and without HS. 2262 subjects were enrolled, 74.5% were males, and the mean age was 39.5 years ±11.8 SD. 984 (44.4%) had HS, 824 (36.4%) had advanced fibrosis. In the CHB group, the AUROC for advanced fibrosis were 0.65 (95% CI 0.62-0.69) for FIB-4 and 0.63 (95% CI 0.60-0.66) for APRI. The specificities were 0.94 for FIB-4 greater than 3.25 and 0.81 for APRI greater than 1.5. In the CHBHS group, the AUROC for advanced fibrosis were 0.67 (95% CI 0.63-0.71) for FIB-4, 0.60 (95% CI 0.56-0.64) for APRI and 0.65 (95% CI 0.61-0.69) for NFS. The specificities were 0.95 for FIB-4 greater than 3.25, 0.88 for APRI greater than 1.5 and 0.99 for NFS greater than 0.675. The performance of NITs to exclude advanced fibrosis did not differ greatly regardless of HS. FIB-4 and NFS have the best negative predictive values of 0.80 and 0.78, respectively, to exclude advanced fibrosis in CHBHS subjects.

A novel non-invasive model for the prediction of advanced liver fibrosis in chronic hepatitis B patients with NAFLD.

Thereare still lack of non-invasive models to evaluate liver fibrosis in chronic hepatitis B (CHB) patients with nonalcoholic fatty liver disease (NAFLD). We aimed to establish a predictive model for advanced fibrosis in these patients. A total of 504 treatment-naive CHB patients with NAFLD who underwent liver biopsy were enrolled and randomly divided into a training set (n=336) and a validation set (n=168). Receiver operating characteristic (ROC) curve was used to compare predicting accuracy for the different models. One hundred fifty-six patients (31.0%) had advanced fibrosis. In the training set, platelet, prothrombin time, type 2 diabetes, HBeAg positivity and globulin were significantly associated with advanced fibrosis by multivariable analysis. A predictive model namely PPDHG for advanced fibrosis was developed based on these parameters. The areas under the ROC curve (AUROC) of PPDHG with an optimal cut-off value of -0.980 in predicting advanced fibrosis was 0.817 (95% confidence interval 0.772 to 0.862), with a sensitivity of 81.82% and a specificity of 66.81%. The predicting accuracy of PPDHG for advanced fibrosis was significantly superior to AST to platelet ratio index (APRI), fibrosis-4 score (FIB-4) and NAFLD fibrosis score (NFS). Further analysis revealed that the AUROC of PPDHG remained significantly higher than FIB-4 and NFS indexes, while it was comparable with APRI for predicting advanced fibrosis in the validation set. PPDHG had a better predicting performance than established models for advanced fibrosis in CHB patients with NAFLD. The application of PPDHG can reduce the necessary for liver biopsy in these patients.

Sensitivity to thyroid hormones is associated with advanced fibrosis in euthyroid patients with non-alcoholic fatty liver disease: A cross-sectional study.

The relationship between thyroid hormone sensitivity and the occurrence of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) remains unclear. We aimed to explore the association between sensitivity to thyroid hormones and advanced fibrosis (F3-F4) of NAFLD in patients with biopsy-proven euthyroid NAFLD. In this study, 129 participants with biopsy-proven euthyroid NAFLD were enrolled, all of whom underwent thyroid function tests and liver biopsy. Indicators reflecting the sensitivity to thyroid hormones were also calculated. A logistic regression model was used to evaluate the association between thyroid hormone sensitivity and risk of advanced liver fibrosis. Among the 129 participants, 40 (31.0%) had advanced fibrosis. Advanced fibrosis was independently associated with TSH, FT3, FT3/FT4, thyrotroph T4 resistance index (TT4RI), TSH index (TSHI), and thyroid feedback quantile-based index (TFQI) (P<0.05), even after adjusting for sex, age, and metabolic factors. The combination of TFQI with age, waist circumference (WC), triglycerides (TGs), and low-density lipoprotein cholesterol (LDL-C) performed best for advanced fibrosis diagnosis. In euthyroid NAFLD patients, higher FT3/FT4, TFQI, TT4RI, and TSHI values were strongly associated with an increased incidence of advanced liver fibrosis. The combination of TFQI with age, WC, TGs, and LDL-C can be used as a predictor for advanced fibrosis in patients with NAFLD.

Evaluation of liver stiffness measurement-based scores in liver transplantation recipients.

Combining bioclinical parameters with liver stiffness measurement (LSM) has improved the diagnostic performance of vibration-controlled transient elastography (VCTE) for detection of advanced fibrosis in patients with chronic liver disease. However, this approach has not yet been tested in liver transplantation (LT) recipients. Thus, the aim of this study was to evaluate the diagnostic performance of combining LSM-based scores with LSM alone for the detection of advanced fibrosis in LT recipients. Adult LT recipients with a liver biopsy, VCTE, and clinical data necessary to construct LSM-based fibrosis models (FibroScan-AST [FAST], AGILE-3+, and AGILE-4) were included ( n = 132). The diagnostic statistics for advanced fibrosis (fibrosis stage 0-2 vs. 3-4) were determined by optimal cut-off using the Youden index. The area under the receiver operating characteristic curve (AUROC) for LSM was 0.94 (95% confidence interval [95% CI], 0.89-0.99), FAST was 0.65 (95% CI, 0.50-0.79), AGILE-3+ was 0.90 (95% CI, 0.83-0.97), and AGILE-4 was 0.90 (95% CI, 0.83-0.97). No statistically significant differences were noted between the AUROC of LSM versus LSM-based scores. The false-positive rates for AGILE-3+ and AGILE-4 were 14.5% and 11.8% compared with 8.3% for LSM alone. The false-positive rates in LSM-based scores were higher among patients with diabetes mellitus, higher AST levels, and lower platelet counts. The LSM-based scores did not improve the diagnostic performance of LSM alone in LT recipients for the detection of advanced fibrosis. This lack of improvement in diagnostic performance results from the impact of immunosuppression on bioclinical profile and underscores the importance of developing LSM-based scores that are specific to LT patients.

Low thyroid function is associated with an increased risk of advanced fibrosis in patients with metabolic dysfunction-associated fatty liver disease

AimsObservational studies showed that low thyroid function may perturb liver function. We aimed to evaluate the association of low thyroid function with both metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced hepatic fibrosis.MethodsParticipants who underwent abdominal ultrasonography and thyroid function test in a Chinese hospital from 2015 to 2021were enrolled. Fibrosis-4 index (FIB-4) > 2.67 and/or non-alcoholic fatty liver disease fibrosis score (NFS) > 0.676 were used to define advanced fibrosis. Descriptive analyses were performed to characterize the epidemiology of MAFLD according to levels of thyroid-stimulating hormone (TSH). The logistic regression model was applied to estimate the association of low thyroid function with MAFLD and advanced fibrosis.ResultsA total of 19,946 participants (52.78% males, mean age: 47.31 years, 27.55% MAFLD) were included, among which 14,789 were strict-normal thyroid function, 4,328 were low-normal thyroid function, 829 were subclinical hypothyroidism. TSH levels were significantly higher in MAFLD patients with a FIB-4 > 2.67 and /or NFS > 0.676 than their counterparts. The logistic regression model adjusted for age and sex showed that low-normal thyroid function increased the risk of MAFLD (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.01–1.18). Multivariable regression model adjusted for age, sex, body mass index, type 2 diabetes, and hypertension showed low-normal thyroid function increased the risk of advanced fibrosis in patients with MAFLD (FIB-4 > 2.67: OR = 1.41, 95% CI 1.02–1.93; NFS > 0.676: OR = 1.72, 95% CI 1.08–2.72).ConclusionElevated TSH concentrations are associated with advanced hepatic fibrosis, even in the euthyroid state.

Risk factors for liver fibrosis progression from early stage to late stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis

OBJECTIVE: The risk factors of fibrosis progression from an early stage to a late stage in non-alcoholic fatty liver disease were systematically analyzed, providing evidence for clinical workers to identify, intervene and block the progression of liver fibrosis in patients at an early stage.METHODS: The author independently used PubMed for a literature search on November 21, 2022. Two researchers independently screened the literature and cross-checked it. Any disputes were resolved by consulting the third researcher. The quality of the literature was evaluated using the Newcastle Ottawa Sca, and Then perform statistical analysis through Review Manager 5.4.RESULTS: Nine kinds of literature were included in this study. A meta-analysis of 11 factors associated with advanced fibrosis in patients with early-stage of nonalcoholic fatty liver disease showed that 5 factors were statistically significant, namely diabetes mellitus (OR=4.04, 95%CI 1.51-10.82, P=0.006). High body mass index (MD=1.89, 95%CI 0.78-3.00, P=0.0009); Low platelet count (MD=-45.05, 95%CI -66.49-(-23.26), P=0.0001); High levels of aspartate aminotransferase (MD=14.92, 95%CI 8.53-21.31, P=0.00001); Low serum albumin (MD=-0.37, 95%CI-0.62-(-0.12), P=0.004). CONCLUSIONS: This study found that diabetes mellitus, high body mass index, low platelet count, high aspartate aminotransferase levels, and low serum albumin may be major risk factors for early fibrosis progression in NAFLD.

Abstract 15217: Intrahepatic Gene Expression Profile Differences in Patients With Fontan Associated Liver Disease

Introduction: Fontan associated liver disease (FALD) develops shortly after the Fontan palliation as the long-term consequence of chronically elevated central venous pressures. The molecular pathways underlying FALD remain largely unknown. We aimed to assess intrahepatic gene expression profile differences among these patients with advanced vs early fibrosis. Hypothesis: Advanced fibrosis in patients with Fontan circulation shows a specific gene expression profile with specific enriched pathways. Methods: This retrospective cohort study included adults with the Fontan circulation who had tissue available from at least one liver biopsy at the UCLA Adult Congenital Heart Disease Center. Clinical, laboratory, imaging and hemodynamic data prior to the liver biopsy were extracted from medical records. Patients were classified into early (F1-F2) or advanced fibrosis (F3-F4). RNA was isolated from formalin-fixed paraffin embedded liver tissue, RNA libraries were constructed using ribosomal RNA depletion method and sequencing was performed on Illumina Novaseq 6000. Differential gene expression and gene ontology analyses were carried out using DESeq2 and Metascape. Results: Seventy-seven patients were included, 53% women, 50% White and 20% Hispanic. Most patients had either a lateral tunnel (40%) or atriopulmonary (24%) Fontan. Four patients had 2 liver biopsies and 1 had hepatocellular carcinoma. Early and advanced fibrosis were present in 43 (54%) and 37 (46%) samples, respectively. Both groups had similar age, comorbidities, NYHA class, liver function tests and liver ultrasound features. Patients with advanced fibrosis had higher BNP, Fontan, mean pulmonary artery and capillary wedge pressures. Samples with advanced fibrosis had 921 up-regulated genes compared to the ones with early fibrosis. The up-regulated genes were enriched in extracellular matrix organization, regulation of cell adhesion, response to wounding, TGF-beta signaling pathway and blood vessel morphogenesis. Conclusions: Advanced fibrosis in patients with Fontan circulation exhibits up-regulated genes compared to early fibrosis, including pathways related to inflammation, congestion and angiogenesis, adding further insight into FALD pathophysiology.

A 3-step approach to predict advanced fibrosis in nonalcoholic fatty liver disease: impact on diagnosis, patient burden, and medical costs

A 2-step approach, Fibrosis-4 index (FIB-4) followed by vibration-controlled transient elastography (VCTE), has been proposed to predict advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to develop a novel 3-step approach for predicting advanced fibrosis. We enrolled 284 biopsy-confirmed NAFLD patients from two tertiary care centers and developed subgroups (n = 190), including 3.7% of patients with advanced fibrosis, assuming a primary care setting. In the 3-step approach, patients with intermediate-to-high FIB-4 in the first step underwent an enhanced liver fibrosis test or measurement of type IV collagen 7S domain as the second step, and VCTE was performed if the second step value was higher than the cutoff. In 284 cases, a tertiary care cohort with 36.3% advanced fibrosis, the 3-step approach showed significantly higher specificity and positive predictive value than the 2-step approach. In the subgroup with 3.7% advanced fibrosis, the 3-step approach significantly reduced the referral rate to specialists, the number of high-risk patients (i.e., liver biopsy candidates), and healthcare costs by 12.5% to 15.8%. The 3-step approach may improve the diagnostic performance to predict advanced fibrosis in NAFLD, which could lower rates of referrals to specialists, liver biopsies, and medical costs.

The gamma-glutamyl transferase to platelet ratio for noninvasive evaluation of liver fibrosis in patients with primary biliary cholangitis.

The gamma-glutamyl transferase to platelet ratio (GPR) has been reported to be as effective as the aspartate transaminase to platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4) in showing the fibrosis stage in patients with chronic hepatitis B. It has been demonstrated that APRI and FIB-4 are successful in the assessment of fibrosis in primary biliary cholangitis (PBC). We investigated the effectiveness of GPR in predicting advanced fibrosis and cirrhosis in patients with biopsy-proven untreated PBC. A total of 35 patients with biopsy-proven PBC were included in this study. The biopsy fibrosis stages of all patients at diagnosis were compared using the APRI, FIB-4, and GPR values. The diagnostic accuracy of GPR for detecting advanced fibrosis and cirrhosis was also investigated. The area under the receiver operating characteristic curve (AUROC) of GPR was 0.84, the cutoff point was 4.81, the sensitivity was 0.41, and the specificity was 0.96 for detecting advanced fibrosis. Our study showed that GPR was more sensitive than APRI and FIB-4 in detecting advanced fibrosis in patients with PBC. GPR could be used as an effective noninvasive marker in PBC to show advanced fibrosis at the time of diagnosis.

How effective are APRI, FIB-4, FIB-5 scores in predicting liver fibrosis in chronic hepatitis B patients?

Liver fibrosis is the most important factor in the prognosis and treatment plan of patients with chronic hepatitis B (CHB). Aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and fibrosis index based on 5 factors (FIB-5) scores are noninvasive fibrosis markers, and previous comparative studies have shown that they are as effective as liver biopsy in detecting liver fibrosis in different liver diseases. The aim of our study is to investigate whether existing scoring systems are effective in demonstrating fibrosis in CHB patients and to compare the APRI, FIB 4, and FIB 5 scores in differentiating early and advanced fibrosis in 123 patients who underwent liver biopsy for CHB infection. APRI, FIB-4, and FIB-5 scores of patients who underwent liver biopsy due to CHB were calculated by means of calculators and recorded to be compared with liver biopsies in terms of fibrosis scoring. One hundred twenty-three patients who underwent liver biopsy due to chronic hepatitis B were included in the study. APRI (area under the receiver-operating characteristic [ROC] curve 0.728), FIB-4 (area under the ROC curve 0.693) and FIB-5 (area under the ROC curve 0.643) scores were evaluated as significant predictors of advanced fibrosis. The scoring system with the highest positive and negative predictive value was evaluated as FIB-4. APRI, FIB-4, and FIB-5 scoring systems are appropriate scoring systems in the assessment of advanced fibrosis in patients with CHB. Our study is the first to compare APRI, FIB-4, and FIB-5 values in CHB patients, and more comprehensive studies are needed.

Risk Predictors of Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease.

The assessment of fibrosis in chronic liver diseases using non-invasive methods is an important topic in hepatology. The aim of this study is to identify patients with non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis by establishing correlations between biological/ultrasound markers and non-invasively measured liver stiffness. This study enrolled 116 patients with non-alcoholic fatty liver disease, which were evaluated clinically, biologically, and by ultrasound. Liver fibrosis was quantified by measuring liver stiffness by shear wave elastography (SWE). Multiple correlation analysis of predictors of liver fibrosis identified a number of clinical, biological, and ultrasound parameters (BMI, blood glucose, albumin, platelet count, portal vein diameter, bipolar spleen diameter) that are associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease. The correlations between the degree of liver fibrosis and the risk values of some serological and ultrasound markers obtained in our study could be useful in clinical practice for the identification of advanced fibrosis in patients with NAFLD.

Patients with type 2 diabetes and elevated fibrosis-4 are under-referred to hepatology and have unrecognized hepatic decompensation.

Background and AimThe American Association for the Study of Liver Diseases recommends a high index of suspicion for nonalcoholic steatohepatitis and advanced fibrosis in patients with type 2 diabetes (T2D) and an elevated fibrosis‐4 index (FIB‐4). We investigated the referral pattern of patients with T2D and FIB4 > 3.25 to the hepatology clinic and evaluated the clinical benefits to the patient.MethodsWe included patients aged 18–80 years with T2D and a FIB4 score >3.25 who had visited the internal medicine, family medicine, endocrinology clinic from 01/01/2014–5/31/2019. The first time point of high‐risk FIB‐4 was identified as the baseline for time‐to‐event analysis. The patients were classified based on whether they had visited the hepatology clinic (referred vs not referred).ResultsOf the 2174 patients, 290 (13.3%) were referred to the hepatology clinic, and 1884 (86.7%) were not referred. In multivariate analyses, the referred patients had a lower overall mortality risk (Hazard Ratio: 0.57; 95% CI: 0.38–87). Notably, the referred patients had the same rate of biochemical decompensation, as measured by progression to MELD ≥ 14, but a substantially higher rate of diagnosis in cirrhosis (27, 19–38) and cirrhosis complications, including ascites (2.9, 2.0–4.1), hepatic encephalopathy (99, 13–742), and liver cancer (14, 5–38).ConclusionsWe found that patients with T2D and high‐risk FIB4 are associated with better overall survival after referral to a hepatology clinic. We speculate that the survival difference is due to the increased recognition of cirrhosis and cirrhosis complications in the referred populations.