Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 12 / 09 / 2021

Articles

Abstract

ORIGINAL ARTICLE

Metabolic Disorders Combined with Noninvasive Tests to Screen Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Yi-Wen Shi1,#, Fang-Ping He2,#, Jin-Jun Chen3, Hong Deng4, Jun-Ping Shi5, Cai-Yan Zhao6, Yu-Qiang Mi7, Zheng-Sheng Zou8, Yong-Jian Zhou9, Fu-Sheng Di10, Rui-Dan Zheng11, Qin Du12, Jia Shang13, Rui-Xu Yang1, Branko Popovic14, Bi-Hui Zhong15,* and Jian-Gao Fan1,*

1  Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
2  Department of Gastroenterology II, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Regions, Ürümqi, China
3  Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
4  Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
5  The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
6  Department of Infectious Disease, The Third Hospital of Hebei Medical University, Shijiazhuang, China
7  Department of Infectious Diseases, Tianjin Second People’s Hospital, Tianjin, China
8  Department of Liver Disease, Chinese PLA General Hospital, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
9  Department of Gastroenterology and Hepatology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
10  Department of Endocrinology and Metabolism, The Third Central Hospital of Tianjin, Tianjin, China
11  Diagnosis and Treatment Center for Liver Diseases, Zhengxing Hospital, Zhangzhou, China
12  Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
13  Department of Infectious Diseases, Henan Provincial Peoples’ Hospital Zhengzhou Zhengzhou, China
14  Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
15  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
#Contributed equally to this work.
*Correspondence to:Bi-Hui Zhong, Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Yuexiu District, Guangzhou, Guangdong 510080, China. ORCID:https://orcid.org/0000-0002-3089-8152. Tel: +86-20-8775-5766-8172, Fax: +86-20-8733-2916, E-mail:This email address is being protected from spambots. You need JavaScript enabled to view it. ; Jian-Gao Fan, Center for Fatty Liver, Department of Gastroenterology, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China. ORCID:https://orcid.org/0000-0002-8618-6402. Tel/Fax: +86-21-2507-7340, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(5):607-614 DOI: 10.14218/JCTH.2021.00058
Received:February 6, 2021 Accepted:April 5, 2021 Published online:April 23, 2021

Abstract

Background and Aims:Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic disorders. This study aimed to explore the role of metabolic disorders in screening advanced fibrosis in NAFLD patients.

Methods:A total of 246 histologically-proven NAFLD patients were enrolled across 14 centers. We compared the severity of fibrosis in patients with different components of metabolic disorders. Based on standard noninvasive tests and metabolic disorders, we developed new algorithms to identify advanced fibrosis.

Results:Metabolic syndrome (MetS) was frequent in NAFLD patients (133/246, 54%). Patients with MetS had a higher proportion of significant fibrosis (p=0.014) and higher LSM values (9.2 kPa, vs. 7.4 kPa, p=0.002) than those without MetS. Patients with more metabolic disorders had higher fibrosis stages (p=0.017). Reduced high-density lipoprotein cholesterol (odds ratio [OR]: 2.241, 95% confidence interval [CI]: 1.004–5.002, p=0.049) and raised fasting glucose (OR: 4.500, 95% CI: 2.083–9.725, p<0.001) were significantly associated with advanced fibrosis. Using these two metabolic disorders as a screening tool, a sensitivity, specificity and accuracy of 92%, 81% and 83% was achieved, respectively. With the new algorithms combining metabolic disorders with noninvasive measurements, the number of patients requiring liver biopsy was reduced, especially in combination with the Fibrosis-4 score and metabolic disorders (36% to 17%, p<0.001). In addition, this stepwise algorithm could achieve a high accuracy (85%) and high negative predictive value (93%).

Conclusions:Metabolic disorders should be taken into consideration in the diagnosis of advanced fibrosis. With further validation and investigation, new algorithms could be recommended in primary care units to spare patients from unnecessary referral and liver biopsies.

Keywords

Nonalcoholic fatty liver disease, Liver fibrosis, Metabolic syndrome, Noninvasive measurement

Journal of Clinical and Translational Hepatology 2021 vol. 9, 607-614  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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