Validation of the new 2021 EASL algorithm for the noninvasive diagnosis of advanced fibrosis in NAFLD

作者：Clémence M. Canivet, Charlotte Costentin, Katharine M. Irvine, Adèle Delamarre, Adrien Lannes, Nathalie Stürm, F. Oberti, Preya Patel, Thomas Decaens, Marie Irlès‐Depé, Isabelle Fouchard, Paul Hermabessière, Marine Roux, Justine Barthelon, Paul Calès, Elizabeth E. Powell, Victor de Lédinghen, Jérôme Boursier · 发表于：Hepatology · 年份：2022 · DOI：10.1002/hep.32665 · 被引用次数：48 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatitis C virus research、Liver Disease and Transplantation

BACKGROUND AND AIMS: The European Association for the Study of the Liver (EASL) has recently proposed an algorithm for the diagnosis of advanced liver fibrosis. We aimed to evaluate the diagnostic accuracy of this algorithm in nonalcoholic fatty liver disease (NAFLD). APPROACH AND RESULTS: One thousand fifty-one patients with NAFLD, liver biopsy, and four noninvasive tests (NITs; Fibrosis-4 [FIB4], vibration controlled transient elastography [VCTE], FibroMeter, Fibrotest) were included. The enhanced liver fibrosis (ELF) score was available in 396 patients. A cohort of 230 patients from primary care/diabetes clinics had FIB4, VCTE, and ELF. Compared with the performance of single NITs, agreement between two NITs (FIB4 and VCTE, VCTE and patented serum tests) increased specificity and positive predictive value by 20%, thus justifying the sequential use proposed in the EASL algorithm. The FIB4/VCTE/FibroMeter and FIB4/VCTE/Fibrotest algorithms performed similarly, providing 85% diagnostic accuracy and a liver biopsy requirement rate of only 10%. The FIB4/VCTE/ELF algorithm performed similarly in the subgroup where ELF was available. Simulations of algorithm accuracies at different prevalence showed that positive predictive values rapidly increased, reaching a plateau above 75% starting at 15% prevalence. Negative predictive values remained higher than 90% up to 25% prevalence. The rate of liver biopsy requirement remained stable, increasing by only 5% between low and high preval...