Non-invasive tests as effective as liver biopsy in predicting clinical outcomes in NAFLD patients
In their latest research with colleagues, Ferenc E Mozes from the University of Oxford found that non-invasive tests have a similar prognostic performance to histologically assessed liver fibrosis. According to them, Histologically assessed liver fibrosis and liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) all provide valuable prognostic information. There is no difference between the prognostic performance of the three biomarkers and histological fibrosis staging on time-dependent receiver operating characteristic curve analysis. The study mentioned that histology and all three biomarkers were significant predictors of clinical outcomes when adjusting for potential confounders.
This study is published in The Lancet.
It is already known that there is prognostic significance of the Histologically assessed liver fibrosis stage in NAFLD ( non-alcoholic fatty liver disease) patients. It is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD.
In this study, researchers aimed to compare the prognostic performance of non-invasive tests with liver histology in NAFLD patients. The team researched literature regarding the diagnostic accuracy of imaging and simple non-invasive tests. The follow-up minimum was of 12 months.
A composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications like ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15 were the primary outcomes measured in the study.
The study results are:
- A total of 65 studies were eligible.
- There was available data on 2518 patients, constituting 44.7 % females and the median age of 54 years with biopsy-proven NAFLD from 25 studies.
- One thousand one hundred sixty-one patients had type 2 diabetes.
- The median follow-up was of 57 months.
- The composite endpoint was observed in 145 patients.
- There were differences between the trichotomised patient groups.
- The tAUC at five years were 0·72, 0.76, 0.74 and 0.70 for histology, LSM-VCTE, FIB-4, and NFS.
Based on the findings from the study, researchers interpreted that Simple non-invasive tests play a crucial role in providing prognostic information.
Similar to histology, these tests predict future clinical outcomes in NAFLD patients and could be an alternative to liver biopsy.
Innovative Medicines Initiative 2 funded the study.
Further reading:
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00141-3/fulltext#%20
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