Diagnosis Of Advanced Fibrosis Research Articles

S1570 Utility of Novel FibroScan-Based Scores in the Diagnosis of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

S1570 Utility of Novel FibroScan-Based Scores in the Diagnosis of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Noninvasive Methods for Detecting Advanced Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B: A Single-Center Retrospective Study.

The performance of noninvasive assessments to rule-in or rule-out fibrosis may improve when combined. We aimed to evaluate the efficiencies of sequential algorithms based on the aspartate aminotransferase-to-platelet ratio index (APRI), the fibrosis index based on four factors (FIB-4), and transient elastography (TE) for the assessment of advanced fibrosis (AF) and cirrhosis. This study enrolled 179 CHB subjects who underwent liver biopsy (LB) before antiviral treatment. AF and cirrhosis were identified in 71 (39.7%) and 28 (15.7%) patients, respectively. Compared with TE alone, sequential FIB-4-TE and APRI-TE algorithms saved a slightly higher number of liver biopsies for the identification of advanced fibrosis (69.3% or 68.2% vs 63.7%, P=0.263 or P=0.372, respectively). For the identification of cirrhosis, sequential FIB-4-TE and APRI-TE algorithms saved a significantly higher number of liver biopsies than TE alone (83.2% or 88.3% vs 69.8%, P=0.003 or P=0.000, respectively). No significant difference was found between the sequential algorithms and TE alone in the diagnostic accuracy for the detection of AF and cirrhosis. The sequential algorithms could significantly reduce the need for liver biopsy with high accuracy for diagnosis of AF and cirrhosis in CHB patients, which would be optimal especially in resource-limited areas.

FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning.

To assess the relationship between clinical biochemical characteristics and steatosis or fibrosis by Fibroscan in non-alcoholic fatty liver disease (NAFLD) patients in order to seek the simple effective screening method closed to the results of the fibroScan measurement. A cross-sectional study was conducted on 188 patients with NAFLD who underwent FibroScan examinations. Demographic data and clinical biochemical characteristics were collected and analyzed. The result showed elevated serum uric acid (SUA) (P = .023, odds ratio [OR = 1.005, 95% CI (1.001-1.009) and metabolic syndrome (MetS) (P = .000, OR = 4.549, 95%CI (1.974-10.484) were associated with severe steatosis (controlled attenuation parameter, CAP ≥ 300 dB/m). The magnitude of liver stiffness measured using FibroScan was positively correlated with aspartate transaminase/alanine aminotransferase (AST/ALT) ratio (R = 0.419, P = .000), AST to platelet ratio index (APRI) score (R = 0.309, P = .000), and Fibrosis-4 score (FIB-4) (R = 0.507, P = .000). The areas under the receiver operating curve (ROC) of AST/ALT, APRI, and FIB-4 for mild or severe fibrosis were 0.563, 0.696, and 0.728, respectively, and those for advanced fibrosis were 0.648, 0.750, and 0.821, respectively. The FIB-4 index cutoff value was 1.65 with a sensitivity of 68.3% and specificity of 89.8% during the diagnosis of advanced fibrosis. MetS and elevated SUA are associated with severe steatosis according to the CAP value screen, whereas FIB-4, as the fibrosis score method, is closer to the liver stiffness measurement results from FibroScan, which may facilitate early warning of NAFLD in the community or in remote areas.

Diagnostic performance of liver fibrosis assessment by quantification of liver surface nodularity on computed tomography and magnetic resonance imaging: systematic review and meta-analysis.

To determine the diagnostic performance of the liver surface nodularity (LSN) score for assessment of hepatic fibrosis. Major databases were searched to identify studies reporting the diagnostic performance of the LSN score published from January 2011 to April 2021. The pooled sensitivity and specificity of the LSN score in the diagnosis of significant fibrosis (F2-4), advanced fibrosis (F3-4), and liver cirrhosis (F4) were calculated using a bivariate random-effects model, and the summary areas under the hierarchical summary receiver operating characteristics curve (AUC) for each were calculated. Subgroup analysis was performed to explore the causes of study heterogeneity. Of 168 screened studies, six were included in the analysis. The pooled sensitivity, specificity, and AUC of the LSN score were 68% (95% confidence interval [CI], 45-84%), 89% (95% CI, 83-93%), and 0.90 (95% CI, 0.87-0.92), respectively, for the diagnosis of significant fibrosis; 88% (95% CI, 60-97%), 78% (95% CI, 57-90%), and 0.89 (95% CI, 0.86-0.91), respectively, for the diagnosis of advanced fibrosis; and 83% (95% CI, 71-91%), 80% (95% CI, 72-85%), and 0.87 (95% CI, 0.83-0.89), respectively, for the diagnosis of liver cirrhosis. Cutoff values of the LSN score affected study heterogeneity in the diagnosis of advanced fibrosis (p = 0.03) and liver cirrhosis (p = 0.01). Imaging modality (p = 0.01) and reference standard (p = 0.01) affected study heterogeneity in the diagnosis of liver cirrhosis. The LSN score showed good diagnostic performance in assessing the hepatic fibrosis stage. Additional investigations are needed to improve and standardize the LSN score. Key Points • The liver surface nodularity (LSN) score showed overall good diagnostic performance in assessing hepatic fibrosis. • The pooled sensitivity of the LSN score was highest in the diagnosis of advanced fibrosis (88%; 95% confidence interval [CI], 60-97%), and the pooled specificity was highest in the diagnosis of significant fibrosis (89%; 95% CI, 83-93%). • The diagnostic performance of the LSN score differed according to the cutoff value, imaging modality, and reference standard.

P-65 CONCORDANCE OF FIB-4 WITH TRANSITION ELASTOGRAPHY IN THE DIAGNOSIS OF ADVANCED LIVER FIBROSIS

Transient elastography (TE) and non-invasive scores such as FIB-4 are non-invasive methods to evaluate liver fibrosis. To evaluate the concordance between TE and FIB-4 in the diagnosis of advanced fibrosis. Observational study. 185 patients (53 ± 14 years, 71.4% women) referred for TE (FibroScan, Echosens). The main indication was non-alcoholic fatty liver disease (46%). Fibrosis staging sections recommended by the manufacturer were used. Clinical data and laboratory tests performed in the 30 days prior to the study were recorded. FIB-4 cuts > 3.45 and <1.45 were used to include and exclude advanced fibrosis, respectively. Statistical analysis by proportion of agreement and kappa index. 26 cases (14.1%) presented advanced fibrosis (F3-F4) according to TE. The proportion according to FIB-4 was 89%, with a kappa index of 0.43. 93.8% of the patients with FIB-4 without advanced fibrosis had a concordant TE evaluation (F0-F2). 59 cases (31.9%) obtained an indeterminate FIB-4 value, of which 52.5%, 30.5% and 17% corresponded to patients without fibrosis, significant fibrosis and advanced fibrosis according to TE, respectively. There is a good concordance between FIB-4 and TE to rule out advanced fibrosis. The FIB-4 does not allow an adequate categorization of the degree of fibrosis in approximately one third of the cases.

Transcriptomics Identify Thrombospondin-2 as a Biomarker for NASH and Advanced Liver Fibrosis.

Background and AimsNAFLD is the most common liver disease worldwide. NASH, the progressive form of NAFLD, and advanced fibrosis are associated with poor outcomes. We searched for their noninvasive biomarkers.Approach and ResultsGlobal RNA sequencing of liver tissue from 98 patients with biopsy‐proven NAFLD was performed. Unsupervised hierarchical clustering well distinguished NASH from nonalcoholic fatty liver (NAFL), and patients with NASH exhibited molecular abnormalities reflecting their pathological features. Transcriptomic analysis identified proteins up‐regulated in NASH and/or advanced fibrosis (stage F3‐F4), including matricellular glycoprotein thrombospondin‐2 (TSP‐2), encoded by the thrombospondin 2 (THBS2) gene. The intrahepatic THBS2 expression level showed the highest areas under the receiver operating characteristic curves (AUROCs) of 0.915 and 0.957 for diagnosing NASH and advanced fibrosis, respectively. THBS2 positively correlated with inflammation and ballooning according to NAFLD activity score, serum aspartate aminotransferase and hyaluronic acid (HA) levels, and NAFLD Fibrosis Score (NFS). THBS2 was associated with extracellular matrix and collagen biosynthesis, platelet activation, caspase‐mediated cleavage of cytoskeletal proteins, and immune cell infiltration. Serum TSP‐2 expression was measured in 213 patients with biopsy‐proven NAFLD, was significantly higher in NASH than in NAFL, and increased parallel to fibrosis stage. The AUROCs for predicting NASH and advanced fibrosis were 0.776 and 0.856, respectively, which were comparable to Fibrosis‐4 index, serum HA level, and NFS in advanced fibrosis diagnosis. Serum TSP‐2 level and platelet count were independent predictors of NASH and advanced fibrosis. Serum TSP‐2 levels could stratify patients with NAFLD according to the risk of hepatic complications, including liver cancer and decompensated cirrhotic events.ConclusionsTSP‐2 may be a useful biomarker for NASH and advanced fibrosis diagnosis in patients with NAFLD.

PERFORMACE OF TRIGLYCERIDE-GLUCOSE INDEX ON DIAGNOSIS AND STAGING OF NAFLD IN OBESE PATIENTS

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the world, and its prevalence is increasing alongside obesity. In United States, NAFLD is already the second leading cause of liver transplantation. The spectrum of the disease ranges from simple steatosis, which has a benign course, to steatohepatitis, which may progress to cirrhosis and its complications. The rising of noninvasive methods for diagnosing and staging non-alcoholic steatohepatitis (NASH) and fibrosis decreases the need of liver biopsy, as well as the costs and the occurrence of complications related to it. To analyze the performance of the triglyceride-glucose index to evaluate steatosis, NASH and liver fibrosis in obese patients with NAFLD. This is a retrospective cross-sectional study. Every medical record of patients who were candidates for bariatric surgery at a leading hospital in Southern Brazil were analyzed. The triglyceride-glucose index (TyG Index), a method composed only of two simple laboratory tests (serum triglycerides and fasting glucose levels), was performed prior to surgery. The TyG Index performance regarding the anatomopathological findings was evaluated, and the AUROC curve was calculated to evaluate the best cut-off point for diagnosing steatosis, non-alcoholic steatohepatitis and liver fibrosis grade. Also, the NAFLD fibrosis Score (NFS) was evaluated. A total of 423 patients were evaluated. The TyG Index with a cut-off point of 8.76 excluded significant simple steatosis (grade 2-3) in obese patients, with 67.6% sensitivity, 65.1% specificity, 46.3% positive predictive value (PPV), 81.8% negative predictive value (NPV), 65.8% accuracy and 0.66 AUROC (P=0.005). In the evaluation of NASH, the TyG Index with a cut-off point of 8.82 excluded significant NASH (grade 2-3) with 57.3% sensitivity, 58.6% specificity, 33.7% PPV, 78.8% NPV, 58.2% accuracy and 0.58 AUROC (P=0.022). When evaluating liver fibrosis, the TyG Index with a cut-off point of 8.91 showed a sensitivity of 61.8%, a specificity of 62.5%, a PPV of 13.8 and a NPV of 94.4% for exclusion of advanced fibrosis (F3-4), with a 62.4% accuracy and 0.69 AUROC (P<0.001). When analyzing the performance of NFS in the diagnosis of advanced fibrosis, the cut-off point <-1.455 excluded advanced fibrosis with sensitivity of 59.4%, specificity of 51%, PPV of 11%, NPV of 92.4% and accuracy of 51.7%. However, the cut-off point of 0.676 to diagnose advanced fibrosis presented sensitivity of 21.9%, specificity of 83%, PPV of 11.7%, NPV of 91.2% and 77.3% accuracy. The AUROC was 0.54 (P=0.480). TyG Index did not perform well in the diagnosis of significant steatosis and NASH. However, it was able to exclude advanced fibrosis in obese patients who are candidates for bariatric surgery.

Assessment of liver fibrosis by transient elastography in young children with chronic hepatitis B\xa0virus infection

BackgroundThis study aimed to compare the diagnostic accuracy of transient elastography (TE) and biopsy for the detection of liver fibrosis in children with chronic hepatitis B (CHB).MethodsThis single-center prospective study included 157 CHB children aged 0–6 years. All patients underwent liver stiffness measurement (LSM) by TE and liver biopsy, separated by an interval of less than 1 week.ResultsThe LSM, aspartate aminotransferase-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) were positively correlated with activity grade and fibrosis stage in CHB children. The areas under the receiver operating characteristic curves (AUCs) of LSM for identifying significant (F ≥ 2) and advanced (F ≥ 3) fibrosis were 0.732 and 0.941, respectively. The cut-off values, specificity, and sensitivity for significant fibrosis were 5.6 kPa, 75.7%, and 67.4%, respectively; the corresponding values for advanced fibrosis were 6.9 kPa, 91.5%, and 81.3%, respectively. Compared to LSM, the overall diagnostic performances of APRI and FIB-4 for significant and advanced fibrosis were suboptimal, with low AUCs and sensitivity. Since LSM, platelet, and Log10 (hepatitis B surface antigen) were independent factors associated with the fibrosis stage (F < 2 and F ≥ 2), they were used to formulate the “LPS” index for the prediction of F ≥ 2. The AUC of LPS (for F ≥ 2) was higher than that of LSM (0.792 vs. 0.732, p < 0.05), and had an improved sensitivity (76.6% vs. 67.4%).ConclusionsTE is a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0–6 years.

Metabolic Disorders Combined with Noninvasive Tests to Screen Advanced Fibrosis in Nonalcoholic Fatty Liver Disease.

Background and AimsNonalcoholic fatty liver disease (NAFLD) is associated with metabolic disorders. This study aimed to explore the role of metabolic disorders in screening advanced fibrosis in NAFLD patients.MethodsA total of 246 histologically-proven NAFLD patients were enrolled across 14 centers. We compared the severity of fibrosis in patients with different components of metabolic disorders. Based on standard noninvasive tests and metabolic disorders, we developed new algorithms to identify advanced fibrosis.ResultsMetabolic syndrome (MetS) was frequent in NAFLD patients (133/246, 54%). Patients with MetS had a higher proportion of significant fibrosis (p=0.014) and higher LSM values (9.2 kPa, vs. 7.4 kPa, p=0.002) than those without MetS. Patients with more metabolic disorders had higher fibrosis stages (p=0.017). Reduced high-density lipoprotein cholesterol (odds ratio [OR]: 2.241, 95% confidence interval [CI]: 1.004–5.002, p=0.049) and raised fasting glucose (OR: 4.500, 95% CI: 2.083–9.725, p<0.001) were significantly associated with advanced fibrosis. Using these two metabolic disorders as a screening tool, a sensitivity, specificity and accuracy of 92%, 81% and 83% was achieved, respectively. With the new algorithms combining metabolic disorders with noninvasive measurements, the number of patients requiring liver biopsy was reduced, especially in combination with the Fibrosis-4 score and metabolic disorders (36% to 17%, p<0.001). In addition, this stepwise algorithm could achieve a high accuracy (85%) and high negative predictive value (93%).ConclusionsMetabolic disorders should be taken into consideration in the diagnosis of advanced fibrosis. With further validation and investigation, new algorithms could be recommended in primary care units to spare patients from unnecessary referral and liver biopsies.

Liver stiffness as measured by two-dimensional shear wave elastography overestimates the stage of fibrosis in patients with chronic hepatitis B and hepatic steatosis

Two-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for measuring liver stiffness (LS) and is used to assess the degree of hepatic fibrosis in patients with chronic hepatitis B (CHB). Despite its usefulness, several factors, other than hepatic fibrosis, can affect its diagnostic accuracy. Hepatic steatosis (HS) is a common lesion in CHB that has increasingly been getting attention in the field of disease development; however, its influence on the measurement of LS remains unclear. We aimed to determine whether HS affects the diagnostic accuracy of 2D-SWE in patients with CHB. Serum parameters and LS values were obtained from 161 patients with CHB. The degrees of hepatic fibrosis and inflammatory activity were estimated based on the METAVIR Cooperative Study Group criteria, and the extent of HS was defined as the percentage of hepatocytes containing fat droplets using oil red staining. We found that LS values were independently correlated with HS in the early stages of hepatic fibrosis (F0-F2 or F0-3). Furthermore, LS values in patients with significant steatosis (S≥10%) were higher than the counterpart in fibrosis stages F0-2 (6.82±1.57 vs. 7.92±1.99; p=0.010) and F0-3 (7.18±1.84 vs. 8.25±1.91; p=0.007). Therefore, false positive rates (FPRs) in the diagnosis of advanced fibrosis (16.00% vs. 37.04%, p=0.037) and cirrhosis (6.67% vs. 21.62%, p=0.030) were higher in patients with significant steatosis. In conclusion, the use of 2D-SWE in the measurement of LS overestimates the stage of hepatic fibrosis in CHB patients with HS>10%. This should be taken into consideration to combine LS results with other non-invasive parameters to improve its accuracy.

Accuracy of Noninvasive Fibrosis Scores to Detect Advanced Fibrosis in Patients With Type-2 Diabetes With Biopsy-proven Nonalcoholic Fatty Liver Disease.

Recent guidelines have recommended screening for nonalcoholic fatty liver disease (NAFLD) and case finding of advanced disease with fibrosis in patients with type-2 diabetes (T2D). The aim of this study is to assess the accuracy of commonly used noninvasive scores to predict the presence of advanced fibrosis (AF) in a large cohort of diabetics in real-life settings. Using International Classification of Diseases, Ninth Revision (ICD-9) codes, all patients with the diagnosis of T2D who had a liver biopsy for suspected NAFLD between January 2000 and December 2015, were identified and analyzed. Patients with secondary causes of hepatic steatosis were excluded. AST/ALT ratio, aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 (FIB-4) index, and Nonalcoholic fatty liver disease Fibrosis Score (NFS) were calculated to predict advanced disease. Sensitivity, specificity, and area under the receiver operator curve were calculated and compared with liver biopsies to predict the overall accuracy of each score. A total of 1319 patients with T2D underwent liver biopsy for suspected NAFLD. After exclusions, 1,157 subjects were included in the final analysis. Our cohort consisted of 64.6% females and 88.4% were whites. Overall, 85% of the population was overweight or obese (body mass index>25 kg/m). Liver biopsy showed 31.7% with AF [Nonalcoholic Steatohepatitis Clinical Research Network (NASH-CRN) stage 3 to 4]. In comparison to liver biopsy, for the diagnosis of AF, AST/ALT>1.4, APRI>1.5, FIB-4>2.67, and NFS>0.676 had reasonable specificities of 84.2%, 97.4%, 69.9%, and 93% but poor sensitivities of 27.4%, 16.5%, 6.7%, and 44.1%, respectively. Even at lower cutoff values of AST/ALT≥1, APRI≥1, and FIB-4≥1.45 sensitivities remained low at 60.7%, 27.9%, and 72.6%, respectively, except for NFS ≥-1.455 with sensitivity of 94.6%, but at this cutoff, its specificity decreased to 16.9%. The area under the receiver operator curve to detect AF was 0.62, 0.74, 0.77, and 0.72, respectively. In this large cohort of adult patients with T2D and NAFLD, commonly used fibrosis scores had reasonable specificity, but poor sensitivity for detecting AF in diabetics. The development of reliable biomarkers for NAFLD/NASH in diabetics is urgently needed.

Assessment of liver fibrosis severity using computed tomography-based liver and spleen volumetric indices in patients with chronic liver disease.

To evaluate whether the liver and spleen volumetric indices, measured on portal venous phase CT images, could be used to assess liver fibrosis severity in chronic liver disease. From 2007 to 2017, 558 patients (mean age 48.7 ± 13.1years; 284 men and 274 women) with chronic liver disease (n = 513) or healthy liver (n = 45) were retrospectively enrolled. The liver volume (sVolL) and spleen volume (sVolS), normalized to body surface area and liver-to-spleen volume ratio (VolL/VolS), were measured on CT images using a deep learning algorithm. The correlation between the volumetric indices and the pathologic liver fibrosis stages combined with the presence of decompensation (F0, F1, F2, F3, F4C [compensated cirrhosis], and F4D [decompensated cirrhosis]) were assessed using Spearman's correlation coefficient. The performance of the volumetric indices in the diagnosis of advanced fibrosis, cirrhosis, and decompensated cirrhosis were evaluated using the area under the receiver operating characteristic curve (AUC). The sVolS (ρ = 0.47-0.73; p < .001) and VolL/VolS (ρ = -0.77-- 0.48; p < .001) showed significant correlation with liver fibrosis stage in all etiological subgroups (i.e., viral hepatitis, alcoholic and non-alcoholic fatty liver, and autoimmune diseases), while the significant correlation of sVolL was noted only in the viral hepatitis subgroup (ρ = - 0.55; p < .001). To diagnose advanced fibrosis, cirrhosis, and decompensated cirrhosis, the VolL/VolS (AUC 0.82-0.88) and sVolS (AUC 0.82-0.87) significantly outperformed the sVolL (AUC 0.63-0.72; p < .001). The VolL/VolS and sVolS may be used for assessing liver fibrosis severity in chronic liver disease. • Volumetric indices of liver and spleen measured on computed tomography images may allow liver fibrosis severity to be assessed in patients with chronic liver disease.

P175 Fatty liver disease as a complication of immune-mediated inflammatory diseases: prevalence and risk factors in inflammatory bowel disease

Abstract Background Previous publications made by our group showed an increased prevalence of fatty liver disease (NAFLD) in immune-mediated inflammatory diseases (IMIDs). However, the existing data on inflammatory bowel disease (IBD) are contradictory. Hypothesis: the prevalence of NAFLD is increased in IBD independently of the presence of metabolic factors. Methods Cross-sectional case–control study. Cases: prospective cohort single-center IBD patients. Controls: random sample from general population (Ethon cohort) paired 1: 2 by age, sex, BMI and T2D diagnosis. The diagnosis of NAFLD has been established by transition elastography (TE) CAP and confirmed by liver biopsy. Results The study scheme is presented in the figure. The prevalence of NAFLD is higher in IBD vs. general population (p = 0.04) and is associated with age, BMI, sex and metabolic syndrome. More frequently, IBD patients with NAFLD presented with severe complications of IBD and to a lesser extent receive TNF therapy. There is a mean serum elevation of CRP, ESR and ferritin compared with IBD subjects without NAFLD. In multivariant analysis, IBD is an independent predictor of NAFLD (adjusted OR 1.31; p = 0.007). The NAFLD associated with IBD is less frequently associated with T2D than NAFLD in the general population, and has a higher proportion of subjects with advanced fibrosis (TE &amp;gt; 8.7 kPa: 45/350 [12.9%] vs. 23/669 [3.4%]; p &amp;lt; 0.0001) and mean value of TE is significantly higher (6.09 vs. 5.11 kPa; p &amp;lt; 0.0001). Non-invasive fibrosis scores have a high NPV in the diagnosis of advanced fibrosis in IBD (FIB4: 88%; APRI: 87%; NFS: 88%; HepametFS: 87 %) Conclusion The prevalence of NAFLD is higher in IBD patients, with IBD being an independent predictor of NAFLD. Patients with IBD and NAFLD have a higher systemic inflammatory burden and this results in an increased risk of advanced fibrosis associated with IBD comparatively with the control NAFLD population.

P783 Non-alcoholic fatty liver disease and advanced liver disease in patients with inflammatory bowel disease: prevalence and risk factors

Abstract Background Increased occurrence of non-alcoholic fatty liver disease NAFLD is observed in patients with IBD. The aim of this study was to assess the prevalence and risk factors of NAFLD and associated advance liver fibrosis in patients with IBD Methods This is a retrospective study. Between January 2010 and August 2019, patients with Crohn’s disease/ulcerative colitis who admitted to our Gastroenterology Unit were included in the study. Hepatic steatosis was assessed by abdominal ultrasound. The diagnosis of advanced fibrosis was evaluated with non-invasive FIB 4 score and FIB-4&amp;gt;3.25 was considered an advanced liver disease. Patients with a history of excessive alcohol or recent steroid use, chronic viral hepatitis and other chronic liver diseases were excluded. Univariate and multivariate analysis were performed. Results Five hundred and thirty-nine, 52% male, mean age 44 ± 18 years, were enrolled. Among 539 IBD patients, 322 (59.7%) in ulcerative colitis patients vs. 217 (41.3%) in Crohn’s disease patients were diagnosed. The sonographic prevalence of NAFLD was 32% (172/539) and advanced liver disease was found in 12% (21/172) in IBD patients with NAFLD. Univariate analysis showed that &amp;gt;40 years old (p = 0.034), ≥25 Body Mass Index (BMI)(p &amp;lt; 0.001), presence of metabolic syndrome(p &amp;lt; 0.001) and type 2 diabetes(p &amp;lt; 0.001), ≥5 years of duration of disease (p &amp;lt; 0.001), biological agents and/or azothiopurine use in the past (p &amp;lt; 0.001), ≥126mg/dl fasting plasma glucose (p = 0.04), elevated alanine aminotransferase (ALT) (p &amp;lt; 0.001), ≥240mg/dl total cholesterol (p = 0.021), ≥150mg/dl triglyceride (p = 0.038) and hyperuricemia (p = 0.019) were risk factors for NAFLD in patients with IBD. According to the multivariate analysis presence of metabolic syndrome and type 2 diabetes, ≥5 years of duration of disease and elevated ALT were an independent predictive factor of NAFLD (respectively, p &amp;lt; 0.003, p = 0.002, p &amp;lt; 0.001, p &amp;lt; 0.001). Univariate analysis showed that &amp;gt;40 years old (p = 0.037), the presence of metabolic syndrome (p &amp;lt; 0.001), type 2 diabetes (p &amp;lt; 0.001) and Crohn’s disease (p = 0.012), history of surgery (p = 0.003), ≥5 years of duration of disease (p &amp;lt; 0.001), elevated ALT (p &amp;lt; 0.001) and &amp;lt;3 mg/dl albumin (p = 0.038) were risk factors for advanced liver disease in IBD patients with NAFLD. According to the multivariate analysis, the presence of type 2 diabetes and ≥5 years of duration of disease was an independent predictive factor of advanced liver disease in IBD patients with NAFLD (respectively, p &amp;lt; 0.001, p &amp;lt; 0.001). Conclusion NAFLD is a very common disease in patients with IBD. NAFLD is not rare cause of advanced liver disease in patients with IBD. Type 2 diabetes and ≥5 years of duration of disease were an independent predictive factor of advanced liver disease in IBD patients with NAFLD.

Assessing liver fibrosis in chronic hepatitis B using MR extracellular volume measurements: Comparison with serum fibrosis indices

ObjectivesTo evaluate the diagnostic value of liver extracellular volume (ECVliver) measurement by equilibrium MR in staging liver fibrosis in chronic hepatitis B (CHB) patients, and to compare its performance with serum fibrosis indices. Materials and methods91 CHB patients were included and underwent gadopentetate dimeglumine-enhanced MRI with T1 mapping sequence before and 15-min after contrast. ECVliver, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (FIB-4) were calculated and compared between fibrosis subgroups, and the correlations between the three indices and fibrosis stage or inflammatory activity were measured by Spearman correlation analysis and stepwise multiple regression analysis. Diagnostic performance in evaluating liver fibrosis stage was assessed and compared using receiver operating characteristic analysis. ResultsInterobserver agreement showed an excellent interclass correlation coefficient of 0.895 for ECVliver. ECVliver, APRI and FIB-4 were different between fibrosis stages as a whole (F/H = 18.44–24.36, P ≤ 0.001). ECVliver had the strongest correlation with fibrosis stage (r = 0.727, P < 0.001), while APRI and FIB-4 had weak correlations (r = 0.466 and 0.440, P < 0.001). Multivariate analysis showed that only ECVliver was independently correlated with fibrosis stage (P < 0.001). The fibrosis stage was the only independent factor correlated with ECVliver comparing to inflammatory activity (P < 0.001). AUCs of ECVliver were larger than both APRI and FIB-4 in fibrosis staging, with significant differences in the diagnosis of advanced fibrosis (≥F3) and cirrhosis (F4) (P = 0.0024 to 0.0049). ConclusionMR ECVliver provides a promising noninvasive tool in staging liver fibrosis for CHB patients, superior to the fibrosis indices of APRI and FIB-4.

The Role Of Non-Invasive Methods In Evaluating Liver Fibrosis Of Patients With Non-Alcoholic Steatohepatitis

Objectives: Liver biopsy is the gold standard for diagnosing the extent of fibrosis in NAFLD/NASH; however, it is invasive with the risk of serious complications. This study aimed to validate the diagnostic usefulness of FIB4, NAFLD Fibrosis Score (NFS), FibroScan and ARFI in assessing liver ?brosis in patients with NAFLD/NASH. Patients and Methods: The study was carried out on 101 patients with NASH. All patients underwent a liver biopsy for histological assessment of liver fibrosis and non-invasive methods for assessment of liver fibrosis including FIB4, NFS, FibroScan, and ARFI. Cut-off values along with the diagnostic accuracy of these methods were determined by receiver-operating characteristic (ROC) curves. Results: Histological liver fibrosis was evaluated by Metavir scoring (F0: 10 cases; F1: 47 cases; F2: 24 cases; F3: 17 cases; and F4: 3 cases). Liver stiffness determined by FIB4, NFS, FibroScan, and ARFI were significantly correlated with the fibrosis stages (Spearman rho: 0.32; 0.51; 0.56 and 0.54; p<0.05, respectively). AUROC of FIB4, NFS, FibroScan and ARFI for diagnosing ≥ F3 were 0.6, 0.8, 0.8, and 0.9, respectively. FibroScan, ARFI v/s NFS were more accurate than FIB4 for diagnosing ≥ F3 (p<0.05). Among those, NFS had the highest sensitivity for diagnoses of ≥ F3. The specificity values of NFS, ARFI and TE were greater than 80% for diagnosing ≥ F3. Conclusions: Liver stiffness determined by these methods had significantly correlated with the fibrosis stages. FibroScan and ARFI had more accurate than NFS and FIB4 in diagnosis of advanced fibrosis. NFS was the best method for screening advanced fibrosis (≥ F3) in patients with NASH.

Fibrosis 4 Score Versus Hyaluronic Acid as Non-Invasive Tools for Assessment of HCV-Related Hepatic Fibrosis: Correlation with Quantitative Morphometric Analysis of Liver Biopsy

1.1.Background & Aims: Unlike the ordinal METAVIR system, morphometry can be used for quantitative assessment of hepatitis C virus (HCV)-related liver fibrosis. However, due to its invasive nature, we tried to study two non-invasive tools for this assessment; namely FIB-4 score and HA level. 1.2.Patients & methods: This study enrolled 99 chronic HCV patients with examination of their biopsy specimens by METAVIR system. Morphometry was performed by the fully automated Leica Qwin image processor and software 2004, Germany. Serum hyaluronic acid was measured using ELISA-based technique and FIB-4 score was calculated using Sterling’s formula. 1.3.Results: Fibrosis percentage quantified by morphometry increases as fibrosis advances. Also, it has significantly positive correlation with serum level of HA (r= .248, p=0.013), as well as FIB4-score (r=.481, p< 0.0001). The cut off values of morphometry fibrosis percentage, FIB-4 score, and HA level for diagnosis of advanced fibrosis (F≥3) are 8.35%, 1.63, and 46.5 ng/ml, respectively. Their diagnostic accuracy has AUC of 0.88, 0.91, & 0.73, respectively. Their sensitivity and specificity are 83% & 91% for morphometry, 83% & 90% for Fib-4 score, and 67% & 85% for HA level. Sensitivities of morphometry and FIB-4 score were not significantly different (p=0.549) while both were significantly better than that of HA (p=0.003 and 0.015, respectively). 1.4.Conclusion: Morphometry is a precise tool for measuring advanced hepatic fibrosis. Although there was significant positive correlation between morphometry fibrosis percent, serum hyaluronic acid level and FIB-4 score, both morphometry and FIB-4 score were better diagnostic tests for advanced fibrosis than HA.

The Fibrosis-Cirrhosis Index (FCI) for Staging of Liver Fibrosis in Chronic Hepatitis C

Background and study aim : Chronic hepatitis C (CHC) is a major global health problem with its consequences of liver fibrosis and cirrhosis. Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment can help determine therapy. Several indices are available to predict cirrhosis. The fibrosis – cirrhosis index (FCI) was proposed to be efficient for none invasive staging of liver fibrosis besides being simple and inexpensive. This study is designed to assess the accuracy of the fibrosis-cirrhosis index (FCI) for non-invasive staging of liver fibrosis in patients with chronic hepatitis C compared to the liver biopsy findings. Patients and methods: This study was conducted on 150 chronic hepatitis C patients who attended the Hepatology, Gastroenterology and Infectious Diseases Department at Benha University Hospital and El Mansoura Health-Insurance Hospital. Another group of 30 healthy subjects (with negative hepatitis viral markers) represented the control group. Results: FCI was a relatively sensitive, specific and accurate marker of fibrosis. At a cutoff value of 0.19 it had a PPV of 82.5% for the diagnosis of advanced fibrosis. Conclusion: FCI is a simple index that integrates ALP, bilirubin, albumin and platelet count for staging fibrosis from absent up to cirrhosis.

The value of noninvasive scoring systems for the diagnosis of advanced fibrosis in Egyptian patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease that includes a spectrum of liver diseases ranging from simple steatosis to steatohepatitis, fibrosis, and cirrhosis. Liver biopsy is the current gold standard for the assessment of fibrosis in patients with NAFLD. However, it is an invasive procedure and not free from complications. We aimed to analyze the diagnostic performance of simple noninvasive scoring systems for the detection of fibrosis in Egyptian patients with NAFLD. Seventy-six patients with biopsy-proven NAFLD were included in the study. Noninvasive scoring systems included AST/ALT ratio (AAR), APRI score, BARD score, FIB-4 score, and NAFLD fibrosis score (NFS). Patients were classified into two groups according to the grade of fibrosis in liver biopsy. Group 1 included 57 patients with no or mild fibrosis (stage 0–2) and group 2 included 19 patients with advanced fibrosis (stage 3–4). The sensitivity, specificity, positive predictive values, negative predictive values, and diagnostic accuracy for relevant cut-offs and area under receiver operating characteristic curves were determined. The area under receiver operating characteristic curves for advanced fibrosis were 0.936 for the FIB-4 score, 0.916 for NFS, 0.907 for the APRI score, 0.840 for AAR, and 0.556 for the BARD score. NFS and the FIB-4 score showed the best diagnostic accuracy (92.6 and 89.7%, respectively), followed by the APRI score (75%), AAR (40.8%), and the BARD score (39.5%). FIB-4 and NFS can be used reliably to diagnose or exclude advanced fibrosis in NAFLD and thus reduce the burden of liver biopsies.

Risk of Liver Decompensation Among HIV/Hepatitis C Virus-Coinfected Individuals With Advanced Fibrosis: Implications for the Timing of Therapy

Most human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-infected patients who are currently receiving boceprevir or telaprevir-based therapy against HCV show cirrhosis. However, the risk of liver decompensation (DC) among HIV/HCV-coinfected patients with stage 3 fibrosis in the short term could be high enough to not allow delays. We aimed at assessing the risk of DC among HIV/HCV-coinfected individuals with advanced fibrosis (F3-F4). Eight hundred ninety-two HIV/HCV-coinfected patients, naive or without sustained virologic response to HCV therapy, were included in this cohort. Fibrosis was staged by biopsy in 317 patients and by liver stiffness measurement (LSM) in 575 individuals. Precirrhosis was defined as an LSM of 9.5-14.6 kilopascals (kPa), and cirrhosis as an LSM of ≥14.6 kPa. For patients with biopsy, the probability of remaining free of DC for F3 vs F4 was 99% (95% confidence interval [CI], 95%-100%) vs 96% (95% CI, 91%-98%) at 1 year, and 98% (95% CI, 94%-100%) vs 87% (95% CI, 81%-92%) at 3 years. The only factor independently associated with DC was fibrosis stage (F4 vs F3, subhazard ratio [SHR], 2.1; 95% CI, 1.07-4.1; P = .032). For patients with LSM, the probability of remaining free of DC for precirrhosis vs cirrhosis was 99% (95% CI, 96%-100%) vs 93% (95% CI, 89%-96%) at 1 year, and 97% (95% CI, 94%-99%) vs 83% (95% CI, 77%-87%) at 3 years. Factors independently associated with DC were platelet count (<100 × 10(3) vs ≥100 × 10(3): SHR, 1.86; 95% CI, 1.01-3.42; P = .046) and LSM (cirrhosis vs precirrhosis: SHR, 5.67; 95% CI, 2.27-14.1; P < .0001). As in patients with cirrhosis, immediate therapy against HCV is warranted for patients with precirrhosis and HIV coinfection, as they are at risk of DC soon after the diagnosis of advanced fibrosis.