Noninvasive liver fibrosis tests effective, accurate in predicting complications in NAFLD
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Vibration-controlled transient elastography and fibrosis-4 index are effective alternatives to liver biopsy when evaluating risk for liver-related events in patients with nonalcoholic fatty liver disease, according to study results.
“The amount of fibrosis in the liver is closely associated with the risk of liver-related complications in nonalcoholic fatty liver disease (NAFLD),” Jerome Boursier, MD, PhD, professor of medicine at the University of Angers in France, and colleagues wrote in the Journal of Hepatology. “Our results show that the blood test [fibrosis-4 index (FIB4)] and transient elastography stratify the risk of liver-related complications in NAFLD, and that transient elastography provides similar prognostic accuracy when compared to liver biopsy. These results argue for the use of noninvasive liver fibrosis tests instead of liver biopsy for the management of patients with NAFLD.”
Boursier and colleagues studied a multicenter cohort of 1,057 NAFLD patients (median age, 55 years; 62% men) with baseline FIB4 and vibration-controlled transient elastography (VCTE) tests, 594 of whom also had a baseline liver biopsy. The primary study outcome during follow-up was liver-related events (LREs), including cirrhosis or hepatocellular carcinoma, and researchers used Harrell’s C-index to evaluate diagnostic accuracy.
According to study results, FIB4 and VCTE were accurate predictors of LREs, with Harrell’s C-indexes greater than 0.80 (0.817 vs. 0.878, respectively; P = .059). In the biopsy subgroup, Harrell’s C-indexes of histological fibrosis staging and VCTE were not significantly different (0.932 vs. 0.881, respectively; P = .164), but both significantly outperformed FIB4 for LRE predictions.
Researchers also found that the FIB4-VCTE algorithm accurately predicted LRE risk: Compared with patients who had an FIB4 less than 1.30, those with FIB4 greater than or equal to 1.30 then VCTE less than 8 kPa had similar risk for LRE (adjusted HR = 1.3; 95% CI, 0.3-6.8), with a recommendation for retesting in 1 to 3 years. The risk increased in those with FIB4 greater than or equal to 1.30 then VCTE 8.0 to 12.0 kPa (aHR = 3.8; 95% CI, 1.3-10.9) and was even higher for those with VCTE greater than 12.0 kPa (aHR = 12.4; 95% CI, 5.1-30.2); referral to a liver specialist was recommended in those patients.
LREs occurred in 62 patients during the 3.1-year median follow-up, with hepatocellular carcinoma occurring in 14 patients and cirrhosis in 48.
“FIB4 and VCTE allow for an accurate prediction of LREs in NAFLD, and therefore position as pertinent tools in place of liver biopsy for the identification of at-risk patients in need of specialized management,” Boursier and colleagues wrote. “The sequential FIB4-VCTE algorithm accurately stratifies LRE risk and should be evaluated in real-life conditions as a referral pathway between primary care physicians and liver specialists.”
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