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NAFLD fibrosis score inaccurate among morbidly obese patients

HONOLULU — NAFLD fibrosis score, a noninvasive marker, and fibrosis on liver histology were not in accordance with each other when used among a population of patients who were morbidly obese and underwent bariatric surgery, according to data presented at ACG 2015.

“In looking for ways other than liver biopsy to describe fibrosis in our NAFLD population, there have been several noninvasive scores developed and noninvasive markers, one being the NAFLD fibrosis score developed in 2007 by Angulo and colleagues,” Sasha Mangray MBBS, MD, department of internal medicine, Virginia Commonwealth University, said during her presentation. “This score performed very well in validation studies and the main goal is to separate patients with and without advanced fibrosis. The aim of our study was to correlate NAFLD fibrosis score with fibrosis on liver histology in a morbidly obese population in a bariatric surgery clinic.”

In a single center retrospective analysis, Mangray and colleagues used the method created by Angulo and colleagues to measure NAFLD fibrosis score among 182 patients who were morbidly obese and underwent bariatric surgery between 2005 and 2014.

“This is a fairly young population, 43.8 being our mean age, and was a mixed population; 69% were white, 31% were African American and the average BMI was 46.5,” Mangray said.

According to the presentation, based on liver histology, 90.7% of patients had nonsignificant fibrosis (F0-F2; n = 165) and 9.3 % had significant fibrosis (F3-F4; n = 17), whereas 29.7 % were found to have nonsignificant fibrosis (n = 54) compared with 70.3 % with significant fibrosis (n = 128) based on NAFLD fibrosis score cut offs.

“Some initial results showed that if we compare liver histology to NAFLD fibrosis score, looking at significant fibrosis, 17 out of the 182 patients were scored as significant on histology. … This led to only 12% of NAFLD fibrosis score[s] and liver biops[ies] correctly being matched. In summary of our results, 12% is what our concordance was for advance fibrosis between liver histology and NAFLD fibrosis score,” Mangray said.
In addition, Mangray and colleagues found that the simple Kappa coefficient of agreement was very low (0.07) and the discordance in agreement was significant based on McNemar's test (P < .0001).

Mangray concluded: “These findings clearly suggest poor predictability of currently available noninvasive tests. There is a presenting need to further explore other noninvasive methods and models that are readily available, affordable, easily accessible and reproducible to be considered as an alternative to liver histology in the morbidly obese population.” – by Melinda Stevens

Reference:

Mangray S, et al. Abstract 64. Presented at: ACG; Oct. 16-21, 2015; Honolulu.

Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.