Fibrotic NASH score may help health care providers predict at-risk patients
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A noninvasive scoring system using routine laboratory data may help primary care providers screen for fibrotic nonalcoholic steatohepatitis and dysmetabolism in high-risk patients, according to a published study.
“A body of evidence shows that individuals with fibrotic NASH, the inflammatory form of [nonalcoholic fatty liver disease (NAFLD)] associated with significant activity and fibrosis, are at risk of developing advanced liver disease,” Federica Tavaglione, MD, of the department of internal medicine and geriatrics at Campus Bio-Medico University in Rome, and colleagues wrote in Clinical Gastroenterology and Hepatology. “The gold standard for diagnosing NASH and liver fibrosis is still a histological assessment by liver biopsy, an invasive and costly procedure that is not devoid of complications.”
Seeking to develop a noninvasive screening method for fibrotic NASH, Tavaglione and colleagues analyzed 264 patients from a derivation cohort of morbidly obese individuals undergoing bariatric surgery, all of whom had no history of alcohol abuse, viral hepatitis or other causes of liver disease. Researchers evaluated external validation in three independent European cohorts of patients at high risk for NAFLD (Finland, n = 370; Italy, n = 947; and England, n = 5,368), and used the area under the receiver operating characteristic curve (AUROC) to estimate performance.
Using stepwise logistic regression analysis, they developed and validated a predictive model called Fibrotic NASH Index (FNI), which included age, gender, BMI, waist circumference, glucose, hemoglobin A1c, total cholesterol, HDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma glutamyltransferase,
platelet count, albumin and total bilirubin.
According to researchers, the performance of the FNI was satisfactory in both derivation and external validation cohorts (AUROC = 0.78 and 0.8-0.95, respectively). In the derivation cohort, the rule-out and rule-in cutoffs were 0.10 for sensitivity 0.89 or greater (negative predictive value = 0.93) and 0.33 for specificity 0.9 or greater (positive predictive value = 0.57). In the external validation cohort, rule-out cutoff sensitivity ranged from 0.87 to 1 (negative predictive value = 0.99-1) and rule-in cutoff specificity from 0.73 to 0.94 (positive predictive value = 0.12-0.49).
“Collectively, our data support that FNI may be useful for ruling out rather than diagnosing fibrotic NASH in at-risk individuals in primary health care and diabetology/endocrinology clinics,” Tavaglione and colleagues wrote. “Individuals with indeterminate and positive results would deserve referral to liver clinic for further investigations and follow-up.”
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