Validation of magnetic resonance elastography plus fibrosis-4 for significant fibrosis in nonalcoholic fatty liver disease.
MEFIB
fibrosis-4 (FIB-4)
liver fibrosis
magnetic resonance elastography (MRE)
nonalcoholic fatty liver disease (NAFLD)
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
25
03
2022
received:
27
01
2022
accepted:
13
05
2022
pubmed:
20
5
2022
medline:
14
9
2022
entrez:
19
5
2022
Statut:
ppublish
Résumé
MEFIB (the combination of magnetic resonance elastography [MRE] ≥ 3.3 kPa and fibrosis-4 (FIB-4) ≥ 1.6) is useful for detecting patients with significant fibrosis (fibrosis stage ≥ 2) having nonalcoholic fatty liver disease (NAFLD). However, age-dependent thresholds of FIB-4 have been proposed, and it remains unclear whether MEFIB could be applied with the same FIB-4 threshold in a different cohort. Therefore, in this study, we examined the best threshold of FIB-4 and validated the utility of MEFIB. This study included 105 biopsy-proven NAFLD patients with contemporaneous MRE assessment. The primary outcome was a diagnostic accuracy for significant fibrosis. The median (interquartile range) age was 65 (58-72) years, and significant fibrosis was 76.2% (80/105). FIB-4 of 2.1 was defined as the best threshold for significant fibrosis in the cohort. The area under the receiver operating characteristics curves (AUROCs) of the combination of MRE and FIB-4 (MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6: 0.80, MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1: 0.84) were higher than those of each index alone (MRE ≥ 3.3 kPa: 0.76, FIB-4 ≥ 1.6: 0.72, and FIB-4 ≥ 2.1: 0.77), but AUROCs of MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6 and MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1 were equivalent (P = 0.3). MEFIB is useful for detecting patients with significant fibrosis and could be utilized in a different cohort without changing the threshold of FIB-4, and it may then be used as a two-step screening strategy.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
MEFIB (the combination of magnetic resonance elastography [MRE] ≥ 3.3 kPa and fibrosis-4 (FIB-4) ≥ 1.6) is useful for detecting patients with significant fibrosis (fibrosis stage ≥ 2) having nonalcoholic fatty liver disease (NAFLD). However, age-dependent thresholds of FIB-4 have been proposed, and it remains unclear whether MEFIB could be applied with the same FIB-4 threshold in a different cohort. Therefore, in this study, we examined the best threshold of FIB-4 and validated the utility of MEFIB.
METHODS
METHODS
This study included 105 biopsy-proven NAFLD patients with contemporaneous MRE assessment. The primary outcome was a diagnostic accuracy for significant fibrosis.
RESULTS
RESULTS
The median (interquartile range) age was 65 (58-72) years, and significant fibrosis was 76.2% (80/105). FIB-4 of 2.1 was defined as the best threshold for significant fibrosis in the cohort. The area under the receiver operating characteristics curves (AUROCs) of the combination of MRE and FIB-4 (MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6: 0.80, MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1: 0.84) were higher than those of each index alone (MRE ≥ 3.3 kPa: 0.76, FIB-4 ≥ 1.6: 0.72, and FIB-4 ≥ 2.1: 0.77), but AUROCs of MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6 and MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1 were equivalent (P = 0.3).
CONCLUSIONS
CONCLUSIONS
MEFIB is useful for detecting patients with significant fibrosis and could be utilized in a different cohort without changing the threshold of FIB-4, and it may then be used as a two-step screening strategy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1726-1731Subventions
Organisme : Japanese Ministry of Health, Labour and Welfare
ID : H30-Kanseisaku-Shitei-003
Organisme : Japan Agency for Medical Research and Development
ID : 22fk0210072s0203
Organisme : Japan Agency for Medical Research and Development
ID : JP20fk0210067h0001
Informations de copyright
© 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Younossi Z, Anstee QM, Marietti M et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat. Rev. Gastroenterol. Hepatol. 2018; 15: 11-20. https://doi.org/10.1038/nrgastro.2017.109
Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat. Rev. Gastroenterol. Hepatol. 2013; 10: 686-690. https://doi.org/10.1038/nrgastro.2013.171
Li J, Zou B, Yeo YH et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2019; 4: 389-398. https://doi.org/10.1016/S2468-1253(19)30039-1
Tampi RP, Wong VW, Wong GL et al. Modelling the economic and clinical burden of non-alcoholic steatohepatitis in East Asia: Data from Hong Kong. Hepatol. Res. 2020; 50: 1024-1031. https://doi.org/10.1111/hepr.13535
Cotter TG, Dong L, Holmen J, Gilroy R, Krong J, Charlton M. Nonalcoholic fatty liver disease: impact on healthcare resource utilization, liver transplantation and mortality in a large, integrated healthcare system. J. Gastroenterol. 2020; 55: 722-730. https://doi.org/10.1007/s00535-020-01684-w
Dulai PS, Singh S, Patel J et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology 2017; 65: 1557-1565. https://doi.org/10.1002/hep.29085
Tamaki N, Higuchi M, Kurosaki M et al. Risk Difference of Liver-Related and Cardiovascular Events by Liver Fibrosis Status in Nonalcoholic Fatty Liver Disease. Clin. Gastroenterol. Hepatol. 2021.
Higuchi M, Tamaki N, Kurosaki M et al. Longitudinal association of magnetic resonance elastography-associated liver stiffness with complications and mortality. Aliment. Pharmacol. Ther. 2022; 55: 292-301. https://doi.org/10.1111/apt.16745
Davison BA, Harrison SA, Cotter G et al. Suboptimal reliability of liver biopsy evaluation has implications for randomized clinical trials. J. Hepatol. 2020; 73: 1322-1332. https://doi.org/10.1016/j.jhep.2020.06.025
Castera L, Friedrich-Rust M, Loomba R. Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2019; 156: 1264, e4-1281. https://doi.org/10.1053/j.gastro.2018.12.036
Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut 2020; 69: 1343-1352. https://doi.org/10.1136/gutjnl-2018-317593
Tamaki N, Kurosaki M, Loomba R, Izumi N. Clinical Utility of Mac-2 Binding Protein Glycosylation Isomer in Chronic Liver Diseases. Ann. Lab. Med. 2021; 41: 16-24. https://doi.org/10.3343/alm.2021.41.1.16
Jung J, Loomba RR, Imajo K et al. MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut 2021; 70: 1946-1953. https://doi.org/10.1136/gutjnl-2020-322976
Tamaki N, Imajo K, Sharpton S et al. Magnetic resonance elastography plus Fibrosis-4 versus FibroScan-aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH-related fibrosis. Hepatology 2022; 75: 661-672. https://doi.org/10.1002/hep.32145
Imajo K, Kessoku T, Honda Y et al. Magnetic Resonance Imaging More Accurately Classifies Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease Than Transient Elastography. Gastroenterology 2016; 150: 626-637.e7. https://doi.org/10.1053/j.gastro.2015.11.048
Park CC, Nguyen P, Hernandez C et al. Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients With Biopsy-Proven Nonalcoholic Fatty Liver Disease. Gastroenterology 2017; 152: 598-607.e2. https://doi.org/10.1053/j.gastro.2016.10.026
Imajo K, Honda Y, Kobayashi T et al. Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease. Clin. Gastroenterol. Hepatol. 2020.
Tamaki N, Higuchi M, Kurosaki M et al. Wisteria floribunda agglutinin-positive mac-2 binding protein as an age-independent fibrosis marker in nonalcoholic fatty liver disease. Sci. Rep. 2019; 9: 10109. https://doi.org/10.1038/s41598-019-46172-1
Takahashi Y, Kurosaki M, Tamaki N et al. Non-alcoholic fatty liver disease fibrosis score and FIB-4 scoring system could identify patients at risk of systemic complications. Hepatol. Res. 2015; 45: 667-675. https://doi.org/10.1111/hepr.12405
Tamaki N, Kurosaki M, Yasui Y et al. Change in Fibrosis 4 Index as Predictor of High Risk of Incident Hepatocellular Carcinoma After Eradication of Hepatitis C Virus. Clin. Infect. Dis. 2021; 73: e3349-e3354. https://doi.org/10.1093/cid/ciaa1307
Ishiba H, Sumida Y, Tanaka S et al. The novel cutoff points for the FIB4 index categorized by age increase the diagnostic accuracy in NAFLD: a multi-center study. J. Gastroenterol. 2018; 53: 1216-1224. https://doi.org/10.1007/s00535-018-1474-y
McPherson S, Hardy T, Dufour JF et al. Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis. Am. J. Gastroenterol. 2017; 112: 740-751. https://doi.org/10.1038/ajg.2016.453
Kleiner DE, Brunt EM, Van Natta M et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41: 1313-1321. https://doi.org/10.1002/hep.20701
Tamaki N, Ajmera V, Loomba R. Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD. Nat. Rev. Endocrinol. 2022; 18: 55-66. https://doi.org/10.1038/s41574-021-00584-0
Gidener T, Ahmed OT, Larson JJ et al. Liver Stiffness by Magnetic Resonance Elastography Predicts Future Cirrhosis, Decompensation, and Death in NAFLD. Clin. Gastroenterol. Hepatol. 2020.
Han MAT, Vipani A, Noureddin N et al. MR elastography-based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: A multicenter study. Liver Int. 2020; 40: 2242-2251. https://doi.org/10.1111/liv.14593
Tamaki N, Higuchi M, Kurosaki M et al. Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct-acting antivirals. J. Viral Hepat. 2019; 26: 893-899. https://doi.org/10.1111/jvh.13103
Higuchi M, Tamaki N, Kurosaki M et al. Prediction of Hepatocellular Carcinoma After Sustained Virological Responses Using Magnetic Resonance Elastography. Clin. Gastroenterol. Hepatol. 2019; 17: 2616-2618. https://doi.org/10.1016/j.cgh.2018.11.046
Sumida Y, Yoneda M, Hyogo H et al. Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012; 12: 2. https://doi.org/10.1186/1471-230X-12-2
Mao X, Liu Z, Shi O et al. Non-invasive fibrosis markers are associated with mortality risk in both general populations and non-alcoholic fatty liver disease patients. Hepatol. Res. 2021; 51: 90-101. https://doi.org/10.1111/hepr.13570
Tamaki N, Kurosaki M, Tanaka K et al. Noninvasive estimation of fibrosis progression overtime using the FIB-4 index in chronic hepatitis C. J. Viral Hepat. 2013; 20: 72-76. https://doi.org/10.1111/j.1365-2893.2012.01635.x
Tamaki N, Kurosaki M, Matsuda S et al. Non-invasive prediction of hepatocellular carcinoma development using serum fibrosis marker in chronic hepatitis C patients. J. Gastroenterol. 2014; 49: 1495-1503. https://doi.org/10.1007/s00535-013-0914-y
Sumida Y, Yoneda M, Tokushige K et al. FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic. Life (Basel) 2021; 11: 143. https://doi.org/10.3390/life11020143
Yoneda M, Imajo K, Takahashi H et al. Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods. J. Gastroenterol. 2018; 53: 181-196. https://doi.org/10.1007/s00535-017-1414-2