NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLDReportar como inadecuado




NIKEI: A New Inexpensive and Non-Invasive Scoring System to Exclude Advanced Fibrosis in Patients with NAFLD - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Aims

To develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease NAFLD derived from routinely obtained clinical and biochemical parameters.

Methods

267 consecutive patients with biopsy proven fatty liver or non-alcoholic steatohepatitis were randomly assigned to the estimation 2-3 or validation 1-3 group to develop a model for the prediction of advanced fibrosis. Univariate statistics were performed to compare patients with and without advanced fibrosis, and following a multivariate logistic regression analysis a new scoring system was constructed. This non-invasive Koeln-Essen-index NIKEI was validated and compared to the FIB-4 index by calculating the area under the receiver operating characteristic curve AUC. We evaluated a stepwise combination of both scoring systems for the precise prediction of advanced fibrosis. To set in contrast, we additionally tested the diagnostic accuracy of the AST-ALT ratio, BARD score and the NAFLD fibrosis score in our cohort.

Results

Age, AST, AST-ALT ratio, and total bilirubin were identified as significant predictors of advanced fibrosis and used to construct the NIKEI with an AUC of 0.968 0.937; 0.998 compared to 0.929 0.869; 0.989 for the FIB-4 index. The absence of advanced fibrosis could be confirmed with excellent accuracy 99–100%. The positive predictive value of the FIB-4 index was higher 100% vs. 60%, however, the false negative rate was also high 33%. With a stepwise combination of both indices 82%–84% of biopsies would have been avoidable without a single misclassification. The AUROC for AST-ALT ratio, the NAFLD fibrosis score, and the BARD score were 0.81 95% CI, 0.72–0.90, 0.96 95% CI 0.92–0.99, and 0.67 95% CI 0.55–0.78, respectively.

Conclusion

The NIKEI can reliably exclude advanced fibrosis in subjects with NAFLD. In combination with the FIB-4 index misclassification with inadequate clinical management can be avoided while the need for liver biopsies can be reduced.



Autor: Münevver Demir , Sonja Lang , Martin Schlattjan, Uta Drebber, Inga Wedemeyer, Dirk Nierhoff, Ingrid Kaul, Jan Sowa, Ali Canbay,

Fuente: http://plos.srce.hr/



DESCARGAR PDF




Documentos relacionados