title: Performance of biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in patients with severe obesity: meta analysis of individual patient data.
abstract: BACKGROUND
  Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.
  
  
  METHODS
  494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.
  
  
  RESULTS
  Prevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance)  =  0.85 (0.83-0.87; P<0.0001); SteatoTest for advanced steatosis = 0.80 (0.79-0.83); and ActiTest for steato-hepatitis = 0.84 (0.82-0.86; P<0.0001). Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63-0.79; P<0.0001); SteatoTest = 0.71 (0.66-0.75; P<0.0001); and ActiTest = 0.74 (0.68-0.79; P<0.0001). Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.
  
  
  CONCLUSIONS
  In patients with severe obesity, a significant diagnostic performance of FibroTest, SteatoTest and ActiTest was observed for liver lesions.
authors.affiliation: APHP UPMC Liver Center, Paris, France. tpoynard@teaser.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lassailly
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Diaz
authors.forename: Karine
authors.initials: K
authors.lastname: Clement
authors.forename: Robert
authors.initials: R
authors.lastname: Caïazzo
authors.forename: Joan
authors.initials: J
authors.lastname: Tordjman
authors.forename: Mona
authors.initials: M
authors.lastname: Munteanu
authors.forename: Hugo
authors.initials: H
authors.lastname: Perazzo
authors.forename: Bernard
authors.initials: B
authors.lastname: Demol
authors.forename: Robert
authors.initials: R
authors.lastname: Callafe
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.forename: Frederic
authors.initials: F
authors.lastname: Charlotte
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism*; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D011933:Reagent Kits, Diagnostic
chemical_list: D015415:Biomarkers; D011933:Reagent Kits, Diagnostic