Comparison of clinical prediction rules for ruling out cirrhosis in nonalcoholic fatty liver disease ( NAFLD )
Year: 2022
Type: article
Abstract: BACKGROUND AND AIMS: Patients with nonalcoholic fatty liver disease (NAFLD) cirrhosis benefit from referral to subspecialty care. While several clinical prediction rules exist to identify advanced fibrosis, the cutoff for excluding cirrhosis due to NAFLD is unclear. This analysis compared clinical prediction rules for excluding biopsy-proven cirrhosis in NAFLD. METHODS: Adult patients were enrolled in the NASH Clinical Research Network (US) and the Newcastle Cohort (UK). Clinical and laboratory data were collected at enrolment, and a liver biopsy was taken within 1 year of enrolment. Optimal cutoffs for each score (eg, FIB-4) to exclude cirrhosis were derived from the US cohort, and sensitivity, specificity, positive predictive value, negative predictive value and AUROC were calculated. The cutoffs were evaluated in the UK cohort. RESULTS: 147/1483 (10%) patients in the US cohort had cirrhosis. All prediction rules had similarly high NPV (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis (AUROC 0.84-0.86). 59/494 (12%) patients in the UK cohort had cirrhosis. Prediction rules had high NPV (0.92-0.96), and FIB-4 and NAFLD fibrosis score the most accurate in the prediction of cirrhosis in the UK cohort (AUROC 0.87-0.89). CONCLUSIONS: This cross-sectional analysis of large, multicentre international datasets shows that current clinical prediction rules perform well in excluding cirrhosis with appropriately chosen cutoffs. These clinical prediction rules can be used in primary care to identify patients, particularly those who are white, female, and <65, unlikely to have cirrhosis so higher-risk patients maintain access to specialty care.
DOI: 10.1111/apt.16874
Authors: Danielle Brandman, Marie Boyle, Stuart McPherson, Mark L. Van Natta, Arun J. Sanyal, Kris Kowdley, Brent Neuschwander‐Tetri, Naga Chalasani, Manal F. Abdelmalek, Norah A. Terrault, Art McCullough, Ricki Bettencourt, Cyrielle Caussy, David E. Kleiner, Cynthia Behling, James Tonascia, Quentin M. Anstee, Rohit Loomba
Institutions: University of California, San Francisco, NIHR Newcastle Biomedical Research Centre, Newcastle University, Johns Hopkins University, Virginia Commonwealth University Medical Center, Saint Louis University, Indiana University Indianapolis, Indiana University School of Medicine, Duke University, University of Southern California, Cleveland Clinic, University of California San Diego, National Institutes of Health, National Cancer Institute, Sharp Memorial Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Takeda Pharmaceuticals North America, Pharmavite, Intercept Pharmaceuticals, National Institute for Health and Care Research, European Commission, National Institutes of Health, Medical Research Council, NIHR Newcastle Biomedical Research Centre, National Cancer Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences
Awards: Continuation of the Nonalcoholic Steatohepatitis Clinical Research Network, San Diego Clinical and Translational Research Institute, G357689415, Institute of Translational Health Sciences, G434337789, Duke CTSA, Center for Clinical and Translational Research, Clinical and Translational Science Institute, G592323822, Washington University Institute of Clinical and Translational Sciences, Indiana Clinical and Translational Science Institute (UL1), Clinical and Translational Science Collaborative of Cleveland, Clinical and Translational Science Collaborative of Cleveland, UC San Diego Clinical and Translational Research Institute, Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN), Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN), Data Coordinating Center for the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) Continuation, Clinical Research Network in Nonalcoholic Steatohepatitis, Collaborative Clinical Research in Nonalcoholic Steatohepatitis, Washington University Institute of Clinical and Translational Sciences, Continuation of the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) Clinical Center-Cleveland site, Clinical Research on Nonalcoholic Fatty Liver Disease, The Saint Louis University Component of the NASH Clinical Research Network, Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
OpenAlex ID: W4221073102