%0 Journal Article
%A Younes, Ramy
%A Caviglia, Gian Paolo
%A Govaere, Olivier
%A Rosso, Chiara
%A Armandi, Angelo
%A Sanavia, Tiziana
%A Pennisi, Grazia
%A Liguori, Antonio
%A Francione, Paolo
%A Gallego-Duran, Rocio
%A Ampuero, Javier
%A Garcia Blanco, Maria J
%A Aller, Rocio
%A Tiniakos, Dina
%A Burt, Alastair
%A David, Ezio
%A Vecchio, Fabio M
%A Maggioni, Marco
%A Cabibi, Daniela
%A Pareja, Maria Jesus
%A Zaki, Marco Y W
%A Grieco, Antonio
%A Fracanzani, Anna L
%A Valenti, Luca
%A Miele, Luca
%A Fariselli, Piero
%A Petta, Salvatore
%A Romero-Gomez, Manuel
%A Anstee, Quentin M
%A Bugianesi, Elisabetta
%T Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease.
%D 2021
%U https://hdl.handle.net/10668/27222
%X Non-invasive scoring systems (NSS) are used to identify patients with non-alcoholic fatty liver disease (NAFLD) who are at risk of advanced fibrosis, but their reliability in predicting long-term outcomes for hepatic/extrahepatic complications or death and their concordance in cross-sectional and longitudinal risk stratification remain uncertain. The most common NSS (NFS, FIB-4, BARD, APRI) and the Hepamet fibrosis score (HFS) were assessed in 1,173 European patients with NAFLD from tertiary centres. Performance for fibrosis risk stratification and for the prediction of long-term hepatic/extrahepatic events, hepatocarcinoma (HCC) and overall mortality were evaluated in terms of AUC and Harrell's c-index. For longitudinal data, NSS-based Cox proportional hazard models were trained on the whole cohort with repeated 5-fold cross-validation, sampling for testing from the 607 patients with all NSS available. Cross-sectional analysis revealed HFS as the best performer for the identification of significant (F0-1 vs. F2-4, AUC = 0.758) and advanced (F0-2 vs. F3-4, AUC = 0.805) fibrosis, while NFS and FIB-4 showed the best performance for detecting histological cirrhosis (range AUCs 0.85-0.88). Considering longitudinal data (follow-up between 62 and 110 months), NFS and FIB-4 were the best at predicting liver-related events (c-indices>0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed limited performance (c-indices 0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed limited performance (c-indices 0.8). All NSS showed limited performance (c-indices  Overall, NFS, HFS and FIB-4 outperformed APRI and BARD for both cross-sectional identification of fibrosis and prediction of long-term outcomes, confirming that they are useful tools for the clinical management of patients with NAFLD at increased risk of fibrosis and liver-related complications or death. Non-invasive scoring systems are increasingly being used in patients with non-alcoholic fatty liver disease to identify those at risk of advanced fibrosis and hence clinical complications. Herein, we compared various non-invasive scoring systems and identified those that were best at identifying risk, as well as those that were best for the prediction of long-term outcomes, such as liver-related events, liver cancer and death.
%K APRI
%K BARD
%K FIB-4
%K HFS
%K NASH
%K NFS
%K NSS
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