Performance of liver biomarkers, in patients at risk of nonalcoholic steato-hepatitis, according to presence of type-2 diabetes

作者：T. Poynard, V. Peta, O. Deckmyn, R. Pais, Y. Ngo, F. Charlotte, A. Ngo, M. Munteanu, F. Imbert‐Bismut, D. Monneret, C. Housset, D. Thabut, D. Valla, C. Boitard, L. Castéra, V. Ratziu · 发表于：European Journal of Gastroenterology and Hepathology · 年份：2019 · DOI：10.1097/MEG.0000000000001606 · 被引用次数：10 · 研究领域：Medicine

Supplemental Digital Content is available in the text. Objective There is a controversy about the performance of blood tests for the diagnostic of metabolic liver disease in patients with type-2-diabetes in comparison with patients without type-2-diabetes. These indirect comparisons assumed that the gold-standard is binary, whereas fibrosis stages, steatosis and nonalcoholic-steato-hepatitis (NASH) grades use an ordinal scale. The primary aim was to compare the diagnostic performances of FibroTest in type-2-diabetes vs. controls matched on gender, age, fibrosis stages and obesity, and taking into account the spectrum effect by Obuchowski measure. Methods Data were retrospectively compared among patients prospectively included, with simultaneous biopsy and blindly assessed FibroTest, SteatoTest-2 and NashTest-2. The secondary aim was to construct an index (SpectrumF3F4-Index) to predict an adjusted-area under the receiver operating curve (AUROC) for F3F4 diagnosis from the prevalences of fibrosis stages, permitting to reduce the spectrum effect when performances of FibroTest, transient elastography and magnetic resonance elastography are indirectly compared. Results In 505 patients at risk of NASH, the Obuchowski measures [95% confidence interval (CI)] of FibroTest, SteatoTest-2 and NashTest-2 were all equivalent in 136 type-2-diabetes cases vs. 369 matched controls: 0.871 (0.837–0.905), vs. 0.880 (0.879–0.881), 0.835 (0.797–0.873) vs. 0.806 (0.780–0.832) and 0.829 (0.793–0.86...