Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET-NASH Study.
Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET-NASH Study.
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DOI：
10.1002/hep4.1689
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发表时间：
2021-06
影响因子：
5.1
通讯作者：
Sanyal AJ
中科院分区：
文献类型：
--
作者：
Barritt AS;Watkins S;Gitlin N;Klein S;Lok AS;Loomba R;Schoen C;Reddy KR;Trinh HN;Mospan AR;Vos MB;Weiss LM;Cusi K;Neuschwander-Tetri BA;Sanyal AJ
目前关于非酒精性脂肪性肝病（NAFLD）的大部分数据来自基于活检的研究，这些研究可能会引入确定和选择偏倚。肝活检患者的选择对NAFLD的临床实践和报告的流行病学有影响。本研究的目的是确定在真实的实践中预测NAFLD组织学与经验性临床诊断的患者因素。本研究纳入了来自TARGET‐NASH的成人。提供了队列的描述性统计量，并比较了组织学NAFLD与临床诊断NAFLD患者的特征，随后采用逻辑回归和机器学习模型描述肝活检的预测因素。分析了3，474例受试者的记录;中位年龄为59岁，59%为女性，75%为白色，中位体重指数为32 kg/m2。使用组织学和/或临床标准，诊断为非酒精性脂肪性肝炎37%，肝硬化33%。合并症包括心血管疾病（19%）、精神健康诊断（49%）和骨关节炎（10%）。活检诊断的预测因素包括白色人种、女性、糖尿病和丙氨酸氨基转移酶（ALT）升高。ALT每升高10分，肝活检的几率增加14%。机器学习分析显示，ALT <69的非白色患者接受肝活检的概率仅为0.06。ALT是决定肝活检的主要变量。结论：在这个真实的NAFLD患者队列中，三分之二的患者没有进行肝活检。这些患者更有可能是非白色、年龄较大、ALT正常的患者，显示出对该人群的潜在了解或知识缺口。本研究的目的是确定在真实的实践中，在入组TARGET‐NASH研究的成人中预测NAFLD组织学与经验性临床诊断的患者因素。分析了3，474例受试者的记录;中位年龄为59岁，59%为女性，75%为白色，中位BMI为32 kg/m2。在这个真实的NAFLD患者队列中，三分之二的患者没有进行肝活检;这些患者更可能是非白色、年龄较大、ALT正常的患者。
Much of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy‐based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real‐world practice. Adults from TARGET‐NASH were included in this study. Descriptive statistics are provided for the cohort and compare the characteristics of histologic NAFLD versus patients with clinically diagnosed NAFLD, followed by logistic regression and machine‐learning models to describe predictors of liver biopsy. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were White, and median body mass index was 32 kg/m2. Using histologic and/or clinical criteria, a diagnosis of nonalcoholic steatohepatitis was made in 37%, and cirrhosis in 33%. Comorbid conditions included cardiovascular disease (19%), mental health diagnoses (49%), and osteoarthritis (10%). Predictors of a biopsy diagnosis included White race, female sex, diabetes, and elevated alanine aminotransferase (ALT). ALT increased the odds of liver biopsy by 14% per 10‐point rise. Machine‐learning analyses showed non‐White patients with ALT <69 had only a 0.06 probability of undergoing liver biopsy. ALT was the dominant variable that determined liver biopsy. Conclusions: In this real‐world cohort of patients with NAFLD, two‐thirds of patients did not have a liver biopsy. These patients were more likely to be non‐White, older, with a normal ALT, showing potential gaps in or knowledge about this population. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real world practice in adults enrolled in the TARGET‐NASH study. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were white, and median BMI was 32 kg/m2. In this real‐world cohort of patients with NAFLD, two thirds of patients did not have a liver biopsy; these patients were more likely to be non‐white, older, with a normal ALT.
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DOI：
10.1056/nejmoa0907929
发表时间：
2010-05-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sanyal AJ;Chalasani N;Kowdley KV;McCullough A;Diehl AM;Bass NM;Neuschwander-Tetri BA;Lavine JE;Tonascia J;Unalp A;Van Natta M;Clark J;Brunt EM;Kleiner DE;Hoofnagle JH;Robuck PR;NASH CRN
通讯作者：
NASH CRN
影响因子：
3.7
作者：
Berden, Floor A. C.;de Knegt, Robert J.;Kievit, Wietske
通讯作者：
Kievit, Wietske
影响因子：
25.7
作者：
Ratziu, Vlad;de Ledinghen, Victor;Spenard, Jean
通讯作者：
Spenard, Jean
影响因子：
4.2
作者：
Rinella, Mary E.;Lominadze, Zurabi;Harrison, Stephen A.
通讯作者：
Harrison, Stephen A.
影响因子：
13.5
作者：
Dutta, Anand;Saha, Chandan;Chalasani, Naga
通讯作者：
Chalasani, Naga