biostudies-literature00460Siddiqui MSNCATS NIH HHSNIDDK NIH HHS1877-1885.e5https://www.ebi.ac.uk/biostudies/studies/S-EPMC6609497biostudies-literatureUnknown17(9)BACKGROUND & AIMS:Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. METHODS:We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. RESULTS:In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). CONCLUSIONS:In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological AssociationDiagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage.PMC6609497U01 DK061718U24 DK061730U01 DK061737U01 DK061728U01 DK061738UL1 TR002548U01 DK061732KL2 TR002648U01 DK061713U01 DK061734U01 DK061731U01 DK061730NASH Clinical Research NetworkSherker AHBuie SNess EDonithan MTonascia JVan Natta MLSternberg AYates KCarpenter DChalasani NKopping MGonzalez MCSiegner JSiddiqui MSBrandman DDavila JFowler KGuy CYost-Schomer LIsaacson MQuist BGill RLavine JEMalik DVuppalanchi RLee JJPoitevin MGawrieh SAng BFreebersyser JClark JMKowdley KVBrunt EMSoo SSirlin CNeuschwander-Tetri BLuketic VACHall SYamada GPenumatsa RMiriel LRobuck PRWriston KNeuschwander-Tetri BAMiddleton MSTerrault NLoomba RWagoner AWilson LAAbdelmalek MFPiercy DBhatt AHameed BMeinert JLai JDoo ECVan Natta MTorrance RJhaveri MMukhtar NBoyett SHallinan ESandrasegaran KDasarathy JSanyal AJCummings OWCattoor TAllende DDasarathy SRagozzino LUngermann ASchlosser JMcCullough AJKigongo CDodge JMaher JPuri PStewart STorretta SDiehl AMBass NMKleiner DEKing DAkhter MFSmith JHoofnagle JHSmith MKirwin SBehling CLazo MBashir MBelt PContos MJYeh M46falseDiagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage.BACKGROUND & AIMS:Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. METHODS:We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. RESULTS:In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). CONCLUSIONS:In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.2019-01-01T00:00:00Z2019 Aug2020-10-31T09:56:02Z2020-10-29T17:07:34ZS-EPMC66094973061602710.1016/j.cgh.2018.12.031