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Preferred Noninvasive Testing for Nonalcoholic Steatohepatitis

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Abstract

Background

There has been an increased interest in the use of noninvasive tests (NITs) to identify advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NALFD). The aim of our study was to define the change in tests’ characteristics (sensitivity and specificity) of different combinations of NITs to detect advanced fibrosis in NAFLD.

Methods

We stratified NITs into first and second tiers and compared two different strategies of combining NITs to screen for advanced fibrosis in patients with NAFLD. One strategy was using NITs in parallel, and the other was using NITs sequentially. Within both of these strategies, there were two ways of interpreting the overall results. The first way was called “the AND rule,” where a positive result required both individual test results to be positive. The second way was called “the OR rule,” where a positive result required only one individual test to be positive. Accuracy of NITs was obtained from the literature search. Combined accuracy and likelihood ratio (LR) were calculated.

Results

Combination testing with parallel and sequential order testing under the AND Rule resulted in overall higher specificity and LR+ then using the NITs alone. Specificity ranged from 0.91 to 0.99, and LR+ from 9.3 to 68.6. The subsequent use of MRE was associated with LR+ between 36 and 69. Sensitivity was higher with parallel and sequential order testing under the OR Rule. LR+ ranged from 1.4 to 7.5, and sensitivity from 0.82 to 0.98.

Conclusion

Screening for advanced fibrosis should be performed sequentially, with positive results confirmed by additional testing. Specificity and LR+ were highest when MRE was employed as the confirmatory test.

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Author information

Authors and Affiliations

  1. Departments of Medicine, Olive-View UCLA Medical Center, Sylmar, CA, USA

    Long Le

  2. Gilead Sciences, Foster City, CA, USA

    Ravina Kullar

  3. Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA

    Hussein M. Saleh & Sammy Saab

  4. Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Sammy Saab

Authors
  1. Long Le
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  2. Ravina Kullar
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  3. Hussein M. Saleh
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  4. Sammy Saab
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Contributions

RK, SS contributed to study concept and design; LL, RK, HMS contributed to acquisition of data; all contributed to analysis and interpretation of data; all contributed to drafting of the manuscript; LL, RK, SS contributed to critical revision of the manuscript for important intellectual content; LL contributed to statistical analysis; N/A contributed to obtained funding; SS contributed to administrative, technical, or material support; study supervision.

Corresponding author

Correspondence to Sammy Saab.

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Conflict of interest

RK is an employee and owns stock at Gilead Pharmaceuticals. SS is on the speaker bureau and honoraria recipient of AbbVie, Bristol Myers Squibb, Bayer, Eisai, Exelixis, Gilead, Intercept, and Salix. He is also an advisor/consultant for: AbbVie, Bayer, Eisai, Exelixis, Gilead, Intercept, Mallinckrodt, and Salix. APP has no disclosure to report.

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Le, L., Kullar, R., Saleh, H.M. et al. Preferred Noninvasive Testing for Nonalcoholic Steatohepatitis. Dig Dis Sci 65, 3719–3725 (2020). https://doi.org/10.1007/s10620-020-06382-4

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  • DOI: https://doi.org/10.1007/s10620-020-06382-4

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