title: Validation of noninvasive biomarkers (FibroTest, SteatoTest, and NashTest) for prediction of liver injury in patients with morbid obesity.
abstract: BACKGROUND
  Liver biopsy is considered as the gold standard for assessing nonalcoholic fatty liver disease (NAFLD) histologic lesions in patients with morbid obesity. The aim of this study was to determine the diagnostic utility of noninvasive markers of fibrosis (FibroTest), steatosis (SteatoTest), and steatohepatitis (NashTest, ActiTest) in these patients.
  
  
  METHODS
  Two hundred and eighty-eight patients presenting with interpretable baseline operative biopsy and biomarkers, in an ongoing prospective cohort of patients treated with bariatric surgery, were included. Histology (NAFLD activity score, or NAFLD scoring system) and biochemical measurements were centralized and blinded to other characteristics. The area under the receiver operating characteristic curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (Obuchowski method) was used to prevent multiple testings and a spectrum effect.
  
  
  RESULTS
  The prevalence of advanced fibrosis (bridging) was 6.9%, advanced steatosis (>33%) was 48%, and steatohepatitis was 6.9% (NAFLD scoring system>4). Weighted AUROCs of the tests were as follows (mean, 95% confidence interval, significance): FibroTest for advanced fibrosis: 0.85, 0.83-0.87, P<0.0001; SteatoTest for advanced steatosis: 0.81, 0.79-0.83, P<0.0001; and ActiTest for steatohepatitis: 0.77, 0.73-0.81, P<0.0001.
  
  
  CONCLUSIONS
  In patients with morbid obesity, the diagnostic performances of the FibroTest, SteatoTest, and ActiTest were statistically significant, thereby possibly reducing the need for biopsy in this population.
authors.affiliation: Service des Maladies de l'Appareil Digestif, Université Lille2, CHRU de Lille, Université Lille2, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lassailly
authors.forename: Robert
authors.initials: R
authors.lastname: Caiazzo
authors.forename: Antoine
authors.initials: A
authors.lastname: Hollebecque
authors.forename: David
authors.initials: D
authors.lastname: Buob
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leteurtre
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnalsteen
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.forename: Marie
authors.initials: M
authors.lastname: Pigeyre
authors.forename: Violeta
authors.initials: V
authors.lastname: Raverdy
authors.forename: Hélène
authors.initials: H
authors.lastname: Verkindt
authors.forename: Marie France
authors.initials: MF
authors.lastname: Six
authors.forename: Carole
authors.initials: C
authors.lastname: Eberle
authors.forename: Alexandre
authors.initials: A
authors.lastname: Patrice
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Monique
authors.initials: M
authors.lastname: Romon
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
mesh_terms: D050110:Bariatric Surgery; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers