[Show abstract][Hide abstract] ABSTRACT: We recently demonstrated that the combination of liver stiffness measurement with NAFLD fibrosis score (NFS), two complementary, easy-to-perform, and widely available tools, is able to accurately diagnose or exclude the presence of severe liver fibrosis, in addition to reducing the number of needed diagnostic liver biopsies by about 50% - 60% . We thank Dr. Sertoglu and colleagues for their comments, which prompted us to further clarify the results of our analyses. First, they pointed out that data from Sicilian and northern Italian patients should be assessed for normal distribution before comparing these patients in terms of demographic, laboratory, metabolic, and histologic variables. In response, we examined the data, and found that only some variables, such as ALT levels, did not have normal distributionThis article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 08/2014; 35(1). DOI:10.1111/liv.12653 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A definite link between non alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) has emerged. Diabetes, older age and the presence of cirrhosis are the key risk factors for HCC in patients with NAFLD. Although the rates of development of HCC are generally lower compared with viral (HCV) aetiology, the absolute burden of NASH-related HCC is higher. Diagnostic delay, older age and the concurrent presence of severe metabolic or vascular disease limits potentially curative treatment, such as liver transplantation. Most worrisome, is the recent evidence that HCC may develop also in non-cirrhotic livers with NAFLD, particularly in the presence of multiple metabolic risk factors. In the coming decades, we expect a change in the burden of the attributable proportion of HCC shifting from viral hepatitis to NASH, as the major risk factor for HCC worldwide.
[Show abstract][Hide abstract] ABSTRACT: Background/AimsThe accuracy of nonivasive tools for the diagnosis of severe fibrosis in patients with nonalcoholic fatty liver disease(NAFLD) in clinical practice is still limited. We aimed at assessing the diagnostic performance of combined noninvasive tools in two independent cohorts of Italian NAFLD patients.Methods
We analyzed data from 321 Italian patients(179 Sicilian-training cohort, and 142 Northern Italy-validation cohort) with an histological diagnosis of NAFLD. Severe fibrosis was defined as fibrosis≥F3 according to Kleiner classification. The APRI, AST/ALT, BARD, FIB-4, and NFS scores were calculated according to published algorithms. Liver stiffness measurement(LSM) was performed by FibroScan. Cut-off points of LSM, NFS and FIB-4 for rule-in or rule-out F3-F4 fibrosis were calculated by the reported formulas.ResultsIn the Sicilian cohort AUCs of LSM, NFS, FIB-4, LSM plus NFS, LSM plus FIB-4, and NFS plus FIB-4 were 0.857, 0.803, 0.790, 0.878, 0.888 and 0.807, respectively, while in the Northern Italy cohort the corresponding AUCs were 0.848, 0.730, 0.703, 0.844, 0.850, and 0.733 respectively. In the training cohort the combination of LSM plus NFS was the best performing strategy, providing false positive, false negative and uncertainty area rates of 0%,1.1% and 48%, respectively. Similar results were obtained in the validation cohort with false positive, false negative and uncertainty area rates of 0%,7.3% and 40.8%.Conclusions
The combination of LSM with NFS, two complementary, easy to perform, and widely available tools, is able to accurately diagnose or exclude the presence of severe liver fibrosis, also reducing of about 50%-60% the number of needed diagnostic liver biopsies.This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 05/2014; 35(5). DOI:10.1111/liv.12584 · 4.41 Impact Factor