RT Journal Article
T1 Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease.
A1 Younes, Ramy
A1 Caviglia, Gian Paolo
A1 Govaere, Olivier
A1 Rosso, Chiara
A1 Armandi, Angelo
A1 Sanavia, Tiziana
A1 Pennisi, Grazia
A1 Liguori, Antonio
A1 Francione, Paolo
A1 Gallego-Duran, Rocio
A1 Ampuero, Javier
A1 Garcia Blanco, Maria J
A1 Aller, Rocio
A1 Tiniakos, Dina
A1 Burt, Alastair
A1 David, Ezio
A1 Vecchio, Fabio M
A1 Maggioni, Marco
A1 Cabibi, Daniela
A1 Pareja, Maria Jesus
A1 Zaki, Marco Y W
A1 Grieco, Antonio
A1 Fracanzani, Anna L
A1 Valenti, Luca
A1 Miele, Luca
A1 Fariselli, Piero
A1 Petta, Salvatore
A1 Romero-Gomez, Manuel
A1 Anstee, Quentin M
A1 Bugianesi, Elisabetta
K1 APRI
K1 BARD
K1 FIB-4
K1 HFS
K1 NASH
K1 NFS
K1 NSS
AB 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.
PB Elsevier BV
YR 2021
FD 2021-06-03
LK https://hdl.handle.net/10668/27222
UL https://hdl.handle.net/10668/27222
LA en
NO Younes R, Caviglia GP, Govaere O, Rosso C, Armandi A, Sanavia T, et al. Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease. J Hepatol. 2021 Oct;75(4):786-794.
DS RISalud
RD Apr 6, 2025