FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study
作者：Philip N. Newsome, M. Sasso, Jonathan J Deeks, Angelo H. Paredes, Jérôme Boursier, Wah‐Kheong Chan, Yusuf Yılmaz, Sébastien Czernichow, Ming‐Hua Zheng, Vincent Wai‐Sun Wong, Michael Allison, Emmanuel Tsochatzis, Quentin M. Anstee, David Sheridan, Peter Eddowes, Indra Neil Guha, Jeremy Cobbold, Valérie Paradis, Pierre Bédossa, Véronique Miette, Céline Fournier‐Poizat, Laurent Sandrin, Stephen Harrison · 发表于：The Lancet. Gastroenterology & hepatology · 年份：2020 · DOI：10.1016/s2468-1253(19)30383-8 · 被引用次数：796 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation
BACKGROUND: The burden of non-alcoholic fatty liver disease (NAFLD) is increasing globally, and a major priority is to identify patients with non-alcoholic steatohepatitis (NASH) who are at greater risk of progression to cirrhosis, and who will be candidates for clinical trials and emerging new pharmacotherapies. We aimed to develop a score to identify patients with NASH, elevated NAFLD activity score (NAS≥4), and advanced fibrosis (stage 2 or higher [F≥2]). METHODS: This prospective study included a derivation cohort before validation in multiple international cohorts. The derivation cohort was a cross-sectional, multicentre study of patients aged 18 years or older, scheduled to have a liver biopsy for suspicion of NAFLD at seven tertiary care liver centres in England. This was a prespecified secondary outcome of a study for which the primary endpoints have already been reported. Liver stiffness measurement (LSM) by vibration-controlled transient elastography and controlled attenuation parameter (CAP) measured by FibroScan device were combined with aspartate aminotransferase (AST), alanine aminotransferase (ALT), or AST:ALT ratio. To identify those patients with NASH, an elevated NAS, and significant fibrosis, the best fitting multivariable logistic regression model was identified and internally validated using boot-strapping. Score calibration and discrimination performance were determined in both the derivation dataset in England, and seven independent international (Franc...