7 research outputs found
Performance of Biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in Patients with Severe Obesity: Meta Analysis of Individual Patient Data
No full textBackground
Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.
Methods
494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.
Results
Prevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance) = 0.85 (0.83–0.87;
Meta-analyses of 3 studies of biomarkers accuracy (Obuchowski measure: weighted area under the ROC curve [wAUROC]) for the diagnostic of liver injury in patients with severe obesity.
No full text<p>FibroTest for the diagnosis of advanced fibrosis (at least equivalent to METAVIR score F2). SteatoTest for the diagnosis of advanced steatosis (>30% steatosis). ActiTest for the diagnosis of NASH (NAS score >4). The horizontal lines indicate the 95% confidence interval for the mean difference between between test's wAUROCs and random (0.500). The vertical lines indicate the equivalence line (0% difference). Positive differences indicate a difference in favor of test). When the horizontal line crosses the vertical line, there is no significant difference. Ave = Average of AUROCs.</p
Sensitivity, specificity and predictive values of biomarkers according to predetermined cutoffs in 494 patients with morbid obesity.
No full text1<p>number of patients n/N and %.</p
Accuracy (weighted area under the ROC curves) of FibroTest, SteatoTest, ActiTest and ALT for the diagnosis of fibrosis, steatosis and NASH adjacent stages/grades in 494 patients with morbid obesity.
No full text<p>Note that the overall Obuchowski measure is not equivalent to an usual area under the ROC curve as weighted according to the distance between stages/grades.</p><p>The overall mean (SE) accuracy of FibroTest (Obuchowski measure) was not significantly greater than that of ALT, Z = −0.3 P = 0.77.</p><p>The overall accuracy of SteatoTest was significantly greater than that of ALT, Z = 5.2 P<0.0001.</p><p>The overall mean accuracy of Actitest (Obuchowski measure) was significantly greater than that of ALT, Z = 4.6 P<0.0001.</p
Included patients with morbid obesity.
No full text<p>*In the Lille cohort a total of 296 patients have been excluded, 94 because histological staging was missing, 19 were duplicate, 229 for biomarkers non assessed (including 39 with more than one cause of exclusion) and 3 patients with not interpretable FT/ST (extreme value of triglycerides/glucose/ApoA1 detected by security algorithms). In the Paris cohort 6 patients have excluded, 2 with BMI lower than 35, 3 because histological staging was missing, and one for biomarkers not assessed. In the Bethune cohort 8 patients have excluded, 3 with BMI lower than 35, and 5 because histological staging was missing.</p
Box Plots of Biomarkers according to liver injury.
No full text<p>FibroTest according to fibrosis stage (Panel A), SteatoTest according to steatosis grade (Panel B), ActiTest according to NAS score (Panel C) to ballooning (Panel D) and inflammation (Panel E) in 494 patients. Notched box plots showing the relationship between tests and the stage/grade of liver injury. The horizontal line inside each box represents the median, and the width of each box the median±1.57 interquartile range/√n (to assess the 95% level of significance between group medians). Failure of the shaded boxes to overlap signifies statistical significance (P<0.05). The horizontal lines above and below each box encompass the interquartile range (from the 25th to 75th percentile), and the vertical lines from the ends of the box encompass the adjacent values (upper: 75th percentile plus 1.5 times interquartile range; lower: 25th percentile minus 1.5 times interquartile range).</p
Characteristics of 494 obese patients included in each population.
No full text1<p>When data are missing the number of patients with data not missing is given.</p
