Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease
Background In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biops...
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| creator | Staufer, Katharina Halilbasic, Emina Spindelboeck, Walter Eilenberg, Magdalena Prager, Gerhard Stadlbauer, Vanessa Posch, Andreas Munda, Petra Marculescu, Rodrig Obermayer-Pietsch, Barbara Stift, Judith Lackner, Carolin Trauner, Michael Stauber, Rudolf E |
| description | Background
In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.
Objective
To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).
Methods
We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).
Results
Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeterV2G (AUROC 0.86, 0.88, 0.89), FibroMeterV3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).
Conclusion
Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS. |
| doi_str_mv | 10.1177/2050640619865133 |
| format | Article |
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In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.
Objective
To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).
Methods
We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).
Results
Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeterV2G (AUROC 0.86, 0.88, 0.89), FibroMeterV3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).
Conclusion
Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.</description><identifier>ISSN: 2050-6406</identifier><identifier>EISSN: 2050-6414</identifier><identifier>DOI: 10.1177/2050640619865133</identifier><identifier>PMID: 31662868</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Austria - epidemiology ; Biopsy - methods ; Diagnosis, Differential ; Elasticity Imaging Techniques - instrumentation ; Elasticity Imaging Techniques - methods ; Enhanced liver fibrosis score ; Female ; FibroMeter ; fibrosis-4 index ; Humans ; Liver Cirrhosis - blood ; Liver Cirrhosis - diagnostic imaging ; Liver Cirrhosis - mortality ; Liver Cirrhosis - pathology ; liver stiffness measurement ; Male ; Middle Aged ; NAFLD fibrosis score ; Non-alcoholic Fatty Liver Disease - complications ; Non-alcoholic Fatty Liver Disease - epidemiology ; Non-alcoholic Fatty Liver Disease - metabolism ; Non-alcoholic Fatty Liver Disease - pathology ; Original ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Risk Assessment ; Sensitivity and Specificity ; vibration-controlled transient elastography</subject><ispartof>United European gastroenterology journal, 2019-10, Vol.7 (8), p.1113-1123</ispartof><rights>Author(s) 2019</rights><rights>2019 The Authors. UEG Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology</rights><rights>Author(s) 2019.</rights><rights>Author(s) 2019 2019 United European Gastroenterology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4841-40f9ceaf354407c330f51dbf5a891b1255a547bab3bc770bb6a5f607c08087673</citedby><cites>FETCH-LOGICAL-c4841-40f9ceaf354407c330f51dbf5a891b1255a547bab3bc770bb6a5f607c08087673</cites><orcidid>0000-0002-3687-9331</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794685/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794685/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,11541,27901,27902,45550,45551,46027,46451,53766,53768</link.rule.ids><linktorsrc>$$Uhttps://onlinelibrary.wiley.com/doi/abs/10.1177%2F2050640619865133$$EView_record_in_Wiley-Blackwell$$FView_record_in_$$GWiley-Blackwell</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31662868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Staufer, Katharina</creatorcontrib><creatorcontrib>Halilbasic, Emina</creatorcontrib><creatorcontrib>Spindelboeck, Walter</creatorcontrib><creatorcontrib>Eilenberg, Magdalena</creatorcontrib><creatorcontrib>Prager, Gerhard</creatorcontrib><creatorcontrib>Stadlbauer, Vanessa</creatorcontrib><creatorcontrib>Posch, Andreas</creatorcontrib><creatorcontrib>Munda, Petra</creatorcontrib><creatorcontrib>Marculescu, Rodrig</creatorcontrib><creatorcontrib>Obermayer-Pietsch, Barbara</creatorcontrib><creatorcontrib>Stift, Judith</creatorcontrib><creatorcontrib>Lackner, Carolin</creatorcontrib><creatorcontrib>Trauner, Michael</creatorcontrib><creatorcontrib>Stauber, Rudolf E</creatorcontrib><title>Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease</title><title>United European gastroenterology journal</title><addtitle>United European Gastroenterol J</addtitle><description>Background
In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.
Objective
To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).
Methods
We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).
Results
Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeterV2G (AUROC 0.86, 0.88, 0.89), FibroMeterV3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).
Conclusion
Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.</description><subject>Adult</subject><subject>Austria - epidemiology</subject><subject>Biopsy - methods</subject><subject>Diagnosis, Differential</subject><subject>Elasticity Imaging Techniques - instrumentation</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>Enhanced liver fibrosis score</subject><subject>Female</subject><subject>FibroMeter</subject><subject>fibrosis-4 index</subject><subject>Humans</subject><subject>Liver Cirrhosis - blood</subject><subject>Liver Cirrhosis - diagnostic imaging</subject><subject>Liver Cirrhosis - mortality</subject><subject>Liver Cirrhosis - pathology</subject><subject>liver stiffness measurement</subject><subject>Male</subject><subject>Middle Aged</subject><subject>NAFLD fibrosis score</subject><subject>Non-alcoholic Fatty Liver Disease - complications</subject><subject>Non-alcoholic Fatty Liver Disease - epidemiology</subject><subject>Non-alcoholic Fatty Liver Disease - metabolism</subject><subject>Non-alcoholic Fatty Liver Disease - pathology</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>vibration-controlled transient elastography</subject><issn>2050-6406</issn><issn>2050-6414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtv1DAUhSMEolXpnhXykk2oHT-zQYJq2iJVYkPX1rVjT11l7MFOAvMT-Nd4OmUESAhv_LjfOb66p2leE_yOECkvOsyxYFiQXglOKH3WnO6fWsEIe348Y3HSnJfygOtSinUde9mcUCJEp4Q6bX6sFhhnmEKKCOKAbNpsIYdSr8mjEr6jmGKIC5SwODS5MhXkU0bb7IZgH2WP3DoGHyzECdUiDAtE6wbkg8mphIJC3PvAaNN9GoNFHqZph8bqmdEQioPiXjUvPIzFnT_tZ83d1erL5U17-_n60-WH29YyxUjLsO-tA085Y1haSrHnZDCeg-qJIR3nwJk0YKixUmJjBHAvKokVVlJIeta8P_huZ7Nxg3VxyjDqbQ4byDudIOg_KzHc63VatJA9E4pXg7dPBjl9netE9CYU68YRoktz0R0lWPBeya6i-IDaOoaSnT9-Q7Deh6j_DrFK3vze3lHwK7IK9AfgWxjd7r-G-m513X28wphRUrXtQVtg7fRDmnPNpPy7mZ92bLfX</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Staufer, Katharina</creator><creator>Halilbasic, Emina</creator><creator>Spindelboeck, Walter</creator><creator>Eilenberg, Magdalena</creator><creator>Prager, Gerhard</creator><creator>Stadlbauer, Vanessa</creator><creator>Posch, Andreas</creator><creator>Munda, Petra</creator><creator>Marculescu, Rodrig</creator><creator>Obermayer-Pietsch, Barbara</creator><creator>Stift, Judith</creator><creator>Lackner, Carolin</creator><creator>Trauner, Michael</creator><creator>Stauber, Rudolf E</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3687-9331</orcidid></search><sort><creationdate>201910</creationdate><title>Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease</title><author>Staufer, Katharina ; Halilbasic, Emina ; Spindelboeck, Walter ; Eilenberg, Magdalena ; Prager, Gerhard ; Stadlbauer, Vanessa ; Posch, Andreas ; Munda, Petra ; Marculescu, Rodrig ; Obermayer-Pietsch, Barbara ; Stift, Judith ; Lackner, Carolin ; Trauner, Michael ; Stauber, Rudolf E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4841-40f9ceaf354407c330f51dbf5a891b1255a547bab3bc770bb6a5f607c08087673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Austria - epidemiology</topic><topic>Biopsy - methods</topic><topic>Diagnosis, Differential</topic><topic>Elasticity Imaging Techniques - instrumentation</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>Enhanced liver fibrosis score</topic><topic>Female</topic><topic>FibroMeter</topic><topic>fibrosis-4 index</topic><topic>Humans</topic><topic>Liver Cirrhosis - blood</topic><topic>Liver Cirrhosis - diagnostic imaging</topic><topic>Liver Cirrhosis - mortality</topic><topic>Liver Cirrhosis - pathology</topic><topic>liver stiffness measurement</topic><topic>Male</topic><topic>Middle Aged</topic><topic>NAFLD fibrosis score</topic><topic>Non-alcoholic Fatty Liver Disease - complications</topic><topic>Non-alcoholic Fatty Liver Disease - epidemiology</topic><topic>Non-alcoholic Fatty Liver Disease - metabolism</topic><topic>Non-alcoholic Fatty Liver Disease - pathology</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>vibration-controlled transient elastography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Staufer, Katharina</creatorcontrib><creatorcontrib>Halilbasic, Emina</creatorcontrib><creatorcontrib>Spindelboeck, Walter</creatorcontrib><creatorcontrib>Eilenberg, Magdalena</creatorcontrib><creatorcontrib>Prager, Gerhard</creatorcontrib><creatorcontrib>Stadlbauer, Vanessa</creatorcontrib><creatorcontrib>Posch, Andreas</creatorcontrib><creatorcontrib>Munda, Petra</creatorcontrib><creatorcontrib>Marculescu, Rodrig</creatorcontrib><creatorcontrib>Obermayer-Pietsch, Barbara</creatorcontrib><creatorcontrib>Stift, Judith</creatorcontrib><creatorcontrib>Lackner, Carolin</creatorcontrib><creatorcontrib>Trauner, Michael</creatorcontrib><creatorcontrib>Stauber, Rudolf E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>United European gastroenterology journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Staufer, Katharina</au><au>Halilbasic, Emina</au><au>Spindelboeck, Walter</au><au>Eilenberg, Magdalena</au><au>Prager, Gerhard</au><au>Stadlbauer, Vanessa</au><au>Posch, Andreas</au><au>Munda, Petra</au><au>Marculescu, Rodrig</au><au>Obermayer-Pietsch, Barbara</au><au>Stift, Judith</au><au>Lackner, Carolin</au><au>Trauner, Michael</au><au>Stauber, Rudolf E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease</atitle><jtitle>United European gastroenterology journal</jtitle><addtitle>United European Gastroenterol J</addtitle><date>2019-10</date><risdate>2019</risdate><volume>7</volume><issue>8</issue><spage>1113</spage><epage>1123</epage><pages>1113-1123</pages><issn>2050-6406</issn><eissn>2050-6414</eissn><abstract>Background
In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.
Objective
To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).
Methods
We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).
Results
Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeterV2G (AUROC 0.86, 0.88, 0.89), FibroMeterV3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).
Conclusion
Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31662868</pmid><doi>10.1177/2050640619865133</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3687-9331</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 2050-6406 |
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| subjects | Adult Austria - epidemiology Biopsy - methods Diagnosis, Differential Elasticity Imaging Techniques - instrumentation Elasticity Imaging Techniques - methods Enhanced liver fibrosis score Female FibroMeter fibrosis-4 index Humans Liver Cirrhosis - blood Liver Cirrhosis - diagnostic imaging Liver Cirrhosis - mortality Liver Cirrhosis - pathology liver stiffness measurement Male Middle Aged NAFLD fibrosis score Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - epidemiology Non-alcoholic Fatty Liver Disease - metabolism Non-alcoholic Fatty Liver Disease - pathology Original Predictive Value of Tests Prevalence Prognosis Prospective Studies Risk Assessment Sensitivity and Specificity vibration-controlled transient elastography |
| title | Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease |
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