Development and Validation of Hepamet Fibrosis Scoring System A Simple, Noninvasive Test to Identify Patients With Nonalcoholic Fatty Liver Disease With Advanced Fibrosis

dc.contributor.authorAmpuero, Javier
dc.contributor.authorPais, Raluca
dc.contributor.authorAller, Rocío
dc.contributor.authorGallego-Durán, Rocío
dc.contributor.authorCrespo, Javier
dc.contributor.authorGarcía-Monzón, Carmelo
dc.contributor.authorBoursier, Jerome
dc.contributor.authorVilar, Eduardo
dc.contributor.authorPetta, Salvatore
dc.contributor.authorMing-Hua, Zheng
dc.contributor.authorEscudero, Desamparados
dc.contributor.authorCalleja, Jose Luis
dc.contributor.authorAspichueta, Patricia
dc.contributor.authorDiago, Moisés
dc.contributor.authorRosales, Jose Miguel
dc.contributor.authorCaballería, Joan
dc.contributor.authorGómez-Camarero, Judith
dc.contributor.authorLo Iacono, Oreste
dc.contributor.authorBenlloch, Salvador
dc.contributor.authorAlbillos, Agustín
dc.contributor.authorTurnes, Juan
dc.contributor.authorBanales, Jesus M.
dc.contributor.authorRatziu, Vlad
dc.contributor.authorRomero-Gómez, Manuel
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2019-08-09T19:12:56Z
dc.date.available2019-08-09T19:12:56Z
dc.date.issued2019
dc.description.abstractBackground & Aims Fibrosis affects prognoses for patients with nonalcoholic fatty liver disease (NAFLD). Several non-invasive scoring systems have aimed to identify patients at risk for advanced fibrosis, but inconclusive results and variations in features of patients (diabetes, obesity and older age) reduce their diagnostic accuracy. We sought to develop a scoring system based on serum markers to identify patients with NAFLD at risk for advanced fibrosis. Methods We collected data from 2452 patients with NAFLD at medical centers in Italy, France, Cuba, and China. We developed the Hepamet fibrosis scoring system using demographic, anthropometric, and laboratory test data, collected at time of liver biopsy, from a training cohort of patients from Spain (n = 768) and validated the system using patients from Cuba (n = 344), Italy (n = 288), France (n = 830), and China (n = 232). Hepamet fibrosis score (HFS) were compared with those of previously developed fibrosis scoring systems (the NAFLD fibrosis score [NFS] and FIB-4). The diagnostic accuracy of the Hepamet fibrosis scoring system was assessed based on area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, diagnostic odds ratio, and positive and negative predictive values and likelihood ratios. Results Variables used to determine HFS were patient sex, age, homeostatic model assessment score, presence of diabetes, levels of aspartate aminotransferase, and albumin, and platelet counts; these were independently associated with advanced fibrosis. HFS discriminated between patients with and without advanced fibrosis with an AUROC curve value of 0.85 whereas NFS or FIB-4 did so with AUROC values of 0.80 (P = .0001). In the validation set, cut-off HFS of 0.12 and 0.47 identified patients with and without advanced fibrosis with 97.2% specificity, 74% sensitivity, a 92% negative predictive value, a 76.3% positive predictive value, a 13.22 positive likelihood ratio, and a 0.31 negative likelihood ratio. HFS were not affected by patient age, body mass index, hypertransaminasemia, or diabetes. The Hepamet fibrosis scoring system had the greatest net benefit in identifying patients who should undergo liver biopsy analysis and led to significant improvements in reclassification, reducing the number of patients with undetermined results to 20% from 30% for the FIB-4 and NFS systems (P < .05). Conclusions Using clinical and laboratory data from patients with NAFLD, we developed and validated the Hepamet fibrosis scoring system, which identified patients with advanced fibrosis with greater accuracy than the FIB-4 and NFS systems. the Hepamet system provides a greater net benefit for the decision-making process to identify patients who should undergo liver biopsy analysis.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationAmpuero, J., Pais, R., Aller, R., Gallego-Durán, R., Crespo, J., García-Monzón, C., … del Pozo Maroto, E. (2019). Development and Validation of Hepamet Fibrosis Scoring System—a Simple, Non-invasive Test to Identify Patients With Nonalcoholic Fatty liver Disease With Advanced Fibrosis. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2019.05.051en_US
dc.identifier.urihttps://hdl.handle.net/1805/20325
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.cgh.2019.05.051en_US
dc.relation.journalClinical Gastroenterology and Hepatologyen_US
dc.rightsPublisher Policyen_US
dc.sourcePublisheren_US
dc.subjectHOMAen_US
dc.subjectsteatosisen_US
dc.subjectprognostic factoren_US
dc.titleDevelopment and Validation of Hepamet Fibrosis Scoring System A Simple, Noninvasive Test to Identify Patients With Nonalcoholic Fatty Liver Disease With Advanced Fibrosisen_US
dc.typeArticleen_US
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