Complex non-invasive fibrosis models are more accurate than simple models in non-alcoholic fatty liver disease
Complex non-invasive fibrosis models are more accurate than simple models in non-alcoholic fatty liver disease
复制标题
DOI：
10.1111/j.1440-1746.2011.06774.x
复制
发表时间：
2011-10-01
影响因子：
4.1
通讯作者：
Jeffrey, Gary P.
中科院分区：
文献类型：
--
作者：
Adams, Leon A.;George, Jacob;Jeffrey, Gary P.
背景和目的：显著的肝纤维化是非酒精性脂肪性肝病（NAFLD）肝脏发病率和死亡率的预后指标;然而，目前尚不清楚非侵入性纤维化模型是否可以确定这一终点。因此，我们在多中心NAFLD cohol.Methods的纤维化范围内比较了简单床旁与复杂纤维化模型的准确性：简单（APRI，BARD）和复杂（Hepascore，Fibrotest，FIB 4）纤维化模型在242名接受肝活检的NAFLD受试者中进行计算。使用Kleiner标准定义显著（F2-4）和晚期纤维化（F3，4）。使用受试者工作特征曲线（AUC）下的面积对模型进行比较。结果：对于显著的纤维化，非侵入性纤维化模型具有中等的准确性（AUC 0.707-0.743），BARD的准确性最低（AUC 0.609，P < 0.05）。使用单一截止值，灵敏度和预测值< 80%;使用两个截止值，> 75%的受试者落入不确定范围内。简单模型中不确定范围内的受试者明显多于复杂模型（分别为99.1-100%和82.1-84.4%，P均< 0.05）。对于晚期纤维化，复合模型的准确性高于BARD模型（AUC 0.802-0.858 vs 0.701，P < 0.05）。使用两个截止值，复杂模型在不确定范围内的个体少于BARD（11.1-32.3% vs 70.7%，P < 0.01）。对于肝硬化，复杂的模型有较高的AUC值比简单models.Conclusions：在NAFLD受试者，非侵入性模型有适度的准确性，确定显着的纤维化，并在大多数受试者的预测值小于90%。在一系列纤维化中，复杂模型比简单的床旁模型更准确。
Background and Aim: Significant hepatic fibrosis is prognostic of liver morbidity and mortality in non-alcoholic fatty liver disease (NAFLD); however, it remains unclear whether non-invasive fibrosis models can determine this end-point. We therefore compared the accuracy of simple bedside versus complex fibrosis models across a range of fibrosis in a multi-centre NAFLD cohort.Methods: Simple (APRI, BARD) and complex (Hepascore, Fibrotest, FIB4) fibrosis models were calculated in 242 NAFLD subjects undergoing liver biopsy. Significant (F2-4) and advanced fibrosis (F3,4) were defined using Kleiner criteria. Models were compared using area under the receiver operator characteristic curves (AUC). Cut-offs were determined by Youden Index or 90% predictive values.Results: For significant fibrosis, non-invasive fibrosis models had modest accuracy (AUC 0.707-0.743) with BARD being least accurate (AUC 0.609, P < 0.05 vs others). Using single cut-offs, sensitivities and predictive values were < 80%; using two cut-offs, > 75% of subjects fell within indeterminate ranges. Simple models had significantly more subjects within indeterminate ranges than complex models (99.1-100% vs 82.1-84.4% respectively, P < 0.05 for all). For advanced fibrosis, complex models were more accurate than BARD (AUC 0.802-0.858 vs 0.701, P < 0.05). Using two cut-offs, complex models had fewer individuals within indeterminate ranges than BARD (11.1-32.3% vs 70.7%, P < 0.01 for all). For cirrhosis, complex models had higher AUC values than simple models.Conclusions: In NAFLD subjects, non-invasive models have modest accuracy for determining significant fibrosis and have predictive values less than 90% in the majority of subjects. Complex models are more accurate than simple bedside models across a range of fibrosis.