title: Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease.
abstract: NAFLD is highly prevalent but only a small subset of patients develop advanced liver fibrosis with impaired liver-related prognosis. We aimed to compare blood fibrosis tests and liver stiffness measurement (LSM) by FibroScan for the diagnosis of liver fibrosis and the evaluation of prognosis in NAFLD.
  
  
  
  Diagnostic accuracy was evaluated in a cross-sectional study including 452 NAFLD patients with liver biopsy (NASH-CRN fibrosis stage), LSM, and eight blood fibrosis tests (BARD, NAFLD fibrosis score, FibroMeter(NAFLD), aspartate aminotransferase to platelet ratio index (APRI), FIB4, FibroTest, Hepascore, FibroMeter(V2G)). Prognostic accuracy was evaluated in a longitudinal study including 360 NAFLD patients.
  
  
  
  LSM and FibroMeter(V2G) were the two best-performing tests in the cross-sectional study: AUROCs for advanced fibrosis (F3/4) were, respectively, 0.831±0.019 and 0.817±0.020 (p⩽0.041 vs. other tests); rates of patients with ⩾90% negative/positive predictive values for F3/4 were 56.4% and 46.7% (p<0.001 vs. other tests); Obuchowski indexes were 0.834±0.014 and 0.798±0.016 (p⩽0.036 vs. other tests). Two fibrosis classifications were developed to precisely estimate the histological fibrosis stage from LSM or FibroMeter(V2G) results without liver biopsy (diagnostic accuracy, respectively: 80.8% vs. 77.4%, p=0.190). Kaplan-Meier curves in the longitudinal study showed that both classifications categorised NAFLD patients into subgroups with significantly different prognoses (p<0.001): the higher was the class of the fibrosis classification, the worse was the prognosis.
  
  
  
  LSM and FibroMeter(V2G) were the most accurate of nine evaluated tests for the non-invasive diagnosis of liver fibrosis in NAFLD. LSM and FibroMeter(V2G) fibrosis classifications help physicians estimate both fibrosis stage and patient prognosis in clinical practice.
  
  
  
  The amount of liver fibrosis is the main determinant of the liver-related prognosis in patients with non-alcoholic fatty liver disease (NAFLD). We evaluated eight blood tests and FibroScan in a cross-sectional diagnostic study and found that FibroScan and the blood test FibroMeter(V2G) were the two most accurate tests for the non-invasive evaluation of liver fibrosis in NAFLD. A longitudinal prognostic study showed these two tests initially developed for the diagnosis are also prognostic markers as they allow for the stratification of NAFLD patients in several subgroups with significantly different prognosis.
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France. Electronic address: JeBoursier@chu-angers.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Guillet
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hiriart
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lannes
authors.affiliation: Service de Pathologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Le Bail
authors.affiliation: Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Michalak
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chermak
authors.affiliation: HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bertrais
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
authors.forename: Maude
authors.initials: M
authors.lastname: Charbonnier
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard-Hubert
authors.affiliation: HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France; Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rousselet
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Angers, France; HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
authors.affiliation: Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université Bordeaux, Bordeaux, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
mesh_terms: D015415:Biomarkers; D001706:Biopsy; D003430:Cross-Sectional Studies; D006801:Humans; D008103:Liver Cirrhosis; D008137:Longitudinal Studies; D065626:Non-alcoholic Fatty Liver Disease; D011379:Prognosis
chemical_list: D015415:Biomarkers
keywords: Blood fibrosis test; Liver stiffness; NAFLD