Diagnosis of different liver fibrosis characteristics by blood tests in non-alcoholic fatty liver disease.
OBJECTIVE
Our aim was to develop an accurate, non-invasive, blood-test-based method for identifying the main characteristics of liver fibrosis in non-alcoholic fatty liver disease (NAFLD).


METHODS
Fibrosis was staged according to NASH-CRN and Metavir systems in 226 patients with NAFLD. A fully automated algorithm measured the fractal dimension (FD) and the area of fibrosis (AOF). Independent predictors of diagnostic targets were determined using bootstrap methods.


RESULTS
(i) Development. Significant fibrosis defined by NASH-CRN F ≥2 was diagnosed by weight, glycaemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and prothrombin index [area under the receiver operating characteristic (AUROC)=0.867]; significant fibrosis defined by Metavir F ≥2 was diagnosed by weight, age, glycaemia, AST, ALT, ferritin and platelets (FibroMeter AUROC=0.941, P<0.005). AOF was estimated by the combination of hyaluronic acid, glycaemia, AST, ALT, platelets and prothrombin index ((a) R(2) =0.530), while FD was estimated by hyaluronic acid, glycaemia, AST/ALT, weight and platelets ((a) R(2) =0.529). (ii) Evaluation. Although NASH-CRN was a better system for fibrosis staging, Metavir staging was a better reference for blood test. Thus, the patient rate with predictive values ≥90% by tests was 97.3% with Metavir reference vs. 66.5% with NASH-CRN reference (P<10(-3)). FibroMeter showed a significantly higher AUROC than the NAFLD fibrosis score for significant fibrosis, but not for severe fibrosis or cirrhosis, with both staging systems. Relationships between fibrosis lesions were well reflected by blood tests, e.g., the correlation between histological area and FD of fibrosis (r(s) =0.971, P<10(-3)) was well reflected by the relationship between respective blood tests (r(s) =0.852, P<10(-3)).


CONCLUSIONS
Different characteristics of fibrosis in NAFLD can be diagnosed and quantified by blood tests with excellent accuracy.
Calès
Paul
P
Service d'Hépato-Gastroentérologie, CHU, Angers, France. paul.cales@univ-angers.fr
Boursier
Jérôme
J
Chaigneau
Julien
J
Lainé
Fabrice
F
Sandrini
Jeremy
J
Michalak
Sophie
S
Hubert
Isabelle
I
Dib
Nina
N
Oberti
Frédéric
F
Bertrais
Sandrine
S
Hunault
Gilles
G
Cavaro-Ménard
Christine
C
Gallois
Yves
Y
Deugnier
Yves
Y
Rousselet
Marie C
MC
D000465:Algorithms; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005234:Fatty Liver / Q000097:blood / Q000150:complications / Q000175:diagnosis; D005260:Female; D017709:Fractals; D006403:Hematologic Tests; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results
D015415:Biomarkers