Original articlePancreas, biliary tract, and liverAccuracy of Noninvasive Scoring Systems in Assessing Risk of Death and Liver-Related Endpoints in Patients With Nonalcoholic Fatty Liver Disease
Section snippets
Subjects
We conducted a retrospective cohort study including all patients diagnosed with biopsy-proven NAFLD, at the Karolinska University Hospital (Huddinge) and Linköping University Hospital, from 1971 to 2009. The methodology for generation of the cohort and the main results are available elsewhere.5 Briefly, we identified all patients that underwent liver biopsy with the finding of steatosis at our institutions. All patients’ medical charts were scrutinized in detail. Patients with causes for
Results
Baseline characteristics of the cohort are presented in Table 1. Median age was 50 years and men comprised 62% of the cohort . The majority (66%) of the participants had NASH, and 12% had advanced (stage 3–4) fibrosis. During a mean follow-up of 19.9 ± 8.7 years (range, 0.4–40 years of age), 214 (33%) persons died and 76 persons (12%) developed severe liver disease. There were 17 (2.6%) cases of death directly attributed to liver disease and there were 12 (1.9%) cases of HCC. Absolute numbers
Discussion
In this retrospective cohort study, we studied the predictive capacity of 4 commonly used noninvasive scoring systems used to identify advanced fibrosis in NAFLD for mortality and severe liver disease. We found that the scores with the highest predictive capacity, both for overall mortality and for severe liver disease, were the FIB-4 and the NFS. However, based on several analyses, all scores only predicted the endpoints to a fair degree. In multivariable modeling and after adding additional
Conclusions
In this retrospective cohort study, the NFS and FIB-4 best predicted overall mortality and severe liver disease after a mean follow-up close to 20 years. However, no score had a clinically acceptable predictive capacity, why new scores aimed directly at predicting prognoses in NAFLD are needed.
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2022, Journal of HepatologyCitation Excerpt :Current risk stratification focuses on assessing the amount of liver fibrosis, but simple non-invasive liver fibrosis tests, such as non-alcoholic fatty liver disease (NAFLD) fibrosis score, fibrosis-4 (FIB-4), or aspartate aminotransferase to platelet ratio index (APRI), are of limited value in individuals in the general population compared to in highly selected NAFLD cohorts from specialist centers.9,10 Significant alcohol use also impairs the performance of these tests,11 and they were not originally designed to predict clinical liver outcomes.12–14 Direct fibrosis biomarkers and special imaging methods, such as elastography, are additionally limited by cost, accessibility, and suboptimal performance in identifying early fibrosis stages and in the presence of alcoholic steatohepatitis.15,16
Conflicts of interest The authors disclose no conflicts.
Funding The work was supported by the Stockholm City Council – Clinical Postdoctoral Appointment (to Hannes Hagström) and a Bengt Ihre Fellowship (to Hannes Hagström).