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Diagnostic accuracy of combined biomarker measurements and vibration-controlled transient elastography (VCTE) for predicting fibrosis stage of non-alcoholic fatty liver disease

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Numerous biomarkers have been developed for assessing the presence and severity of liver fibrosis associated with non-alcoholic fatty liver disease (NAFLD). Fibrosis can be assessed by liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE). Here we examined whether diagnostic accuracy and applicability can be further improved by combining various biomarker measurements with LSM.

Methods

A total of 278 patients with biopsy-confirmed Japanese NAFLD patients were enrolled. Area under the receiver operator characteristic curve (AUROC) was evaluated for obtaining the optimum interpretation criteria for LSM by VCTE and comparing various biomarkers alone and in combination with LSM.

Results

Liver stiffness measurements including cases with interquartile range (IQR)/median (M) < 30% or LSM ≤ 7.1 kPa demonstrated high applicability (90% of patients with NAFLD) and accuracy (AUROC: 0.891) for predicting stage ≥ 3 fibrosis. For all biomarkers tested, the AUROC values for predicting stage ≥ 3 fibrosis were increased when combined with LSM [platelet count, 0.734 vs. 0.912; type-4 collagen 7s (T4C7s), 0.894 vs. 0.921; aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), 0.774 vs. 0.906; AST to platelet ratio index, 0.789 vs. 0.902; FIB-4 index, 0.828 vs. 0.922; NAFLD fibrosis score, 0.800 vs. 0.906; CA index-fibrosis, 0.884 vs. 0.913; FM-fibro index, 0.920 vs. 0.943; FIB-4 index + T4C7s, 0.901 vs. 0.930], demonstrating the advantage of concurrent LSM.

Conclusions

While VCTE has slightly limited applicability (90%) for patients with NAFLD, concurrent measurement with certain biomarkers (especially FM-fibro, T4C7s, and FIB-4) greatly improves the diagnostic accuracy.

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Abbreviations

AUROC:

The area under the receiver operator characteristic curve

cfNRI:

Category-free net reclassification improvement

IDI:

Integrated discrimination improvement

IQR/M:

Interquartile range/median

LSM:

Liver stiffness measurement

NAFLD:

Non-alcoholic fatty liver disease

NFS:

NAFLD fibrosis score

NPV:

Negative predictive value

PLT:

Platelet count

PPV:

Positive predictive value

T4C7s:

Type-4 collagen 7s

VCTE:

Vibration-controlled transient elastography

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Funding

This research is supported by AMED under Grant Number JP19fk0210040 (T.O.).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan

    Toshihide Shima, Hirohisa Oya, Takayuki Katayama, Yasuhide Mitsumoto, Masayuki Mizuno & Takeshi Okanoue

  2. Clinical Laboratory, Saiseikai Suita Hospital, Suita, Japan

    Kyoko Sakai

  3. Health Informatics, Kyoto University School of Public Health, Kyoto, Japan

    Kyoko Sakai

  4. Hepato-Biliary-Pancreatic Surgery, Saiseikai Suita Hospital, Suita, Japan

    Yoshihiro Kanbara

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  1. Toshihide Shima
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Correspondence to Takeshi Okanoue.

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T. Shima has received research funding from Bristol-Myers Squibb. All authors have no conflicts of interest to report.

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Shima, T., Sakai, K., Oya, H. et al. Diagnostic accuracy of combined biomarker measurements and vibration-controlled transient elastography (VCTE) for predicting fibrosis stage of non-alcoholic fatty liver disease. J Gastroenterol 55, 100–112 (2020). https://doi.org/10.1007/s00535-019-01626-1

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