Liver Stiffness Measurements in Patients with Different Stages of Nonalcoholic Fatty Liver Disease: Diagnostic Performance and Clinicopathological Correlation
Digestive Diseases and Sciences, 08/03/2012
Kumar R et al. – Liver stiffness measurement (LSM) is a useful tool for evaluation of patients with nonalcoholic fatty liver disease (NAFLD), and is the best among other non–invasive predictors of liver fibrosis.Methods
- A total of 307 subjects (120 NAFLD, 85 NAFLD related cirrhosis, and 102 healthy controls) were studied.
- In NAFLD patients, LSM had significant correlation with fibrosis (r=0.68, p<0.001), and increased progressively with increasing fibrosis (p<0.001).
- However, the difference between stage 1 and stage 2 fibrosis was not significant (p=0.07).
- The LSM in NAFLD without fibrosis and healthy controls was similar (p=0.37).
- The areas under receiver-operating characteristics (AUROC) curve of LSM for stages ≥1, ≥2, ≥3, and 4 were 0.82, 0.85, 0.94, and 0.96, respectively.
- The best LSM (kPa) cut-offs for fibrosis stages ≥1, ≥2, ≥3 and 4 were 6.1, 7.0, 9.0, and 11.8, respectively.
- The negative predictive value of LSM for excluding advanced fibrosis was 95 %.
- For advanced fibrosis, the AUROC curve of LSM was 0.94, followed by FIB-4 (0.75), BARD score (0.68), NAFLD fibrosis score (0.66), and aspartate platelet ratio index (0.60).
- In multivariate analysis, LSM was the only independent predictor of advanced fibrosis (odds ratio 1.47).
- In patients with NAFLD cirrhosis, LSM correlated significantly with Child-Pugh score (r=0.40, p<0.001), serum bilirubin (r=0.34, p=0.02), and grades of esophageal varices (r=0.23, p=0.04).