Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis
Identifieur interne : 002396 ( Main/Merge ); précédent : 002395; suivant : 002397Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis
Auteurs : Stuart Mcpherson [Royaume-Uni] ; Tim Hardy [Royaume-Uni] ; Jean-Francois Dufour [Suisse] ; Salvatore Petta [Italie] ; Manuel Romero-Gomez [Espagne] ; Mike Allison [Royaume-Uni] ; Claudia P. Oliveira [Brésil] ; Sven Francque [Belgique] ; Luc Van Gaal [Belgique] ; Jörn M. Schattenberg [Allemagne] ; Dina Tiniakos [Royaume-Uni] ; Alastair Burt [Australie] ; Elisabetta Bugianesi [Italie] ; Vlad Ratziu [France] ; Christopher P. Day [Royaume-Uni] ; Quentin M. Anstee [Royaume-Uni]Source :
- The American Journal of Gastroenterology [ 0002-9270 ] ; 2016.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Alanine transaminase (sang), Aspartate aminotransferases (sang), Biopsie, Cirrhose du foie (anatomopathologie), Cirrhose du foie (diagnostic), Cirrhose du foie (sang), Cirrhose du foie (étiologie), Courbe ROC, Facteurs de l'âge, Faux positifs, Femelle, Foie (anatomopathologie), Humains, Mâle, Numération des plaquettes, Stéatose hépatique non alcoolique (), Sujet âgé, Valeur prédictive des tests, Valeurs de référence.
- MESH :
- anatomopathologie : Cirrhose du foie, Foie.
- diagnostic : Cirrhose du foie.
- sang : Alanine transaminase, Aspartate aminotransferases, Cirrhose du foie.
- étiologie : Cirrhose du foie.
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Biopsie, Courbe ROC, Facteurs de l'âge, Faux positifs, Femelle, Humains, Mâle, Numération des plaquettes, Stéatose hépatique non alcoolique, Sujet âgé, Valeur prédictive des tests, Valeurs de référence.
English descriptors
- KwdEn :
- Adult, Age Factors, Aged, Alanine Transaminase (blood), Area Under Curve, Aspartate Aminotransferases (blood), Biopsy, False Positive Reactions, Female, Humans, Liver (pathology), Liver Cirrhosis (blood), Liver Cirrhosis (diagnosis), Liver Cirrhosis (etiology), Liver Cirrhosis (pathology), Male, Middle Aged, Non-alcoholic Fatty Liver Disease (complications), Platelet Count, Predictive Value of Tests, ROC Curve, Reference Values.
- MESH :
- chemical , blood : Alanine Transaminase, Aspartate Aminotransferases.
- blood : Liver Cirrhosis.
- complications : Non-alcoholic Fatty Liver Disease.
- diagnosis : Liver Cirrhosis.
- etiology : Liver Cirrhosis.
- pathology : Liver, Liver Cirrhosis.
- Adult, Age Factors, Aged, Area Under Curve, Biopsy, False Positive Reactions, Female, Humans, Male, Middle Aged, Platelet Count, Predictive Value of Tests, ROC Curve, Reference Values.
Abstract
Non-invasive fibrosis scores are widely used to identify/exclude advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). However, these scores were principally developed and validated in patients aged between 35 and 65 years of age. The objective of this study was to assess the effect of age on the performance of non-invasive fibrosis tests in NAFLD.
Patients were recruited from European specialist hepatology clinics. The cohort was divided into five age-based groups: ≤35 (
Six hundred and thirty-four patients were included. The diagnostic accuracy of the AST/ALT ratio was lower than NFS and FIB-4 in all the age groups. The AST/ALT ratio, NFS, and FIB-4 score performed poorly for a diagnosis of advanced fibrosis in those aged ≤35 years (area under the receiver operating characteristic curves (AUROCs 0.52, 0.52, and 0.60, respectively). For all groups >35 years, AUROCs for advanced fibrosis were similar for the NFS and FIB-4 score (range 0.77–0.84). However, the specificity for advanced fibrosis using the FIB-4 and NFS declined with age, becoming unacceptably low in those aged ≥65 years (35% for FIB-4 and 20% for NFS). New cutoffs were derived (and validated) for those aged ≥65 years, which improved specificity to 70% without adversely affecting sensitivity (FIB-4 2.0, sensitivity 77% NFS 0.12, sensitivity 80%).
The NFS and FIB-4 scores have similar accuracy for advanced fibrosis in patients aged >35 years. However, the specificity for advanced fibrosis is unacceptably low in patients aged ≥65 years, resulting in a high false positive rate. New thresholds for use in patients aged ≥65 years are proposed to address this issue.
Url:
DOI: 10.1038/ajg.2016.453
PubMed: 27725647
PubMed Central: 5418560
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis</title>
<author><name sortKey="Mcpherson, Stuart" sort="Mcpherson, Stuart" uniqKey="Mcpherson S" first="Stuart" last="Mcpherson">Stuart Mcpherson</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University</institution>
, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital</institution>
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</nlm:aff>
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<author><name sortKey="Hardy, Tim" sort="Hardy, Tim" uniqKey="Hardy T" first="Tim" last="Hardy">Tim Hardy</name>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital</institution>
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<author><name sortKey="Dufour, Jean Francois" sort="Dufour, Jean Francois" uniqKey="Dufour J" first="Jean-Francois" last="Dufour">Jean-Francois Dufour</name>
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, Berne,<country>Switzerland</country>
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<country xml:lang="fr">Suisse</country>
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<author><name sortKey="Petta, Salvatore" sort="Petta, Salvatore" uniqKey="Petta S" first="Salvatore" last="Petta">Salvatore Petta</name>
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, Palermo,<country>Italy</country>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Romero Gomez, Manuel" sort="Romero Gomez, Manuel" uniqKey="Romero Gomez M" first="Manuel" last="Romero-Gomez">Manuel Romero-Gomez</name>
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</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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</nlm:aff>
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<author><name sortKey="Oliveira, Claudia P" sort="Oliveira, Claudia P" uniqKey="Oliveira C" first="Claudia P" last="Oliveira">Claudia P. Oliveira</name>
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</nlm:aff>
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<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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</nlm:aff>
<country xml:lang="fr">Belgique</country>
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</nlm:aff>
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</nlm:aff>
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<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Tiniakos, Dina" sort="Tiniakos, Dina" uniqKey="Tiniakos D" first="Dina" last="Tiniakos">Dina Tiniakos</name>
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, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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, Adelaide,<country>Australia</country>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Bugianesi, Elisabetta" sort="Bugianesi, Elisabetta" uniqKey="Bugianesi E" first="Elisabetta" last="Bugianesi">Elisabetta Bugianesi</name>
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, Turin,<country>Italy</country>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Ratziu, Vlad" sort="Ratziu, Vlad" uniqKey="Ratziu V" first="Vlad" last="Ratziu">Vlad Ratziu</name>
<affiliation wicri:level="1"><nlm:aff id="aff13"><institution>Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital</institution>
, Paris,<country>France</country>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Day, Christopher P" sort="Day, Christopher P" uniqKey="Day C" first="Christopher P" last="Day">Christopher P. Day</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University</institution>
, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital</institution>
, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Anstee, Quentin M" sort="Anstee, Quentin M" uniqKey="Anstee Q" first="Quentin M" last="Anstee">Quentin M. Anstee</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University</institution>
, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital</institution>
, Newcastle upon Tyne,<country>UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">The American Journal of Gastroenterology</title>
<idno type="ISSN">0002-9270</idno>
<idno type="eISSN">1572-0241</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Age Factors</term>
<term>Aged</term>
<term>Alanine Transaminase (blood)</term>
<term>Area Under Curve</term>
<term>Aspartate Aminotransferases (blood)</term>
<term>Biopsy</term>
<term>False Positive Reactions</term>
<term>Female</term>
<term>Humans</term>
<term>Liver (pathology)</term>
<term>Liver Cirrhosis (blood)</term>
<term>Liver Cirrhosis (diagnosis)</term>
<term>Liver Cirrhosis (etiology)</term>
<term>Liver Cirrhosis (pathology)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Non-alcoholic Fatty Liver Disease (complications)</term>
<term>Platelet Count</term>
<term>Predictive Value of Tests</term>
<term>ROC Curve</term>
<term>Reference Values</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Aire sous la courbe</term>
<term>Alanine transaminase (sang)</term>
<term>Aspartate aminotransferases (sang)</term>
<term>Biopsie</term>
<term>Cirrhose du foie (anatomopathologie)</term>
<term>Cirrhose du foie (diagnostic)</term>
<term>Cirrhose du foie (sang)</term>
<term>Cirrhose du foie (étiologie)</term>
<term>Courbe ROC</term>
<term>Facteurs de l'âge</term>
<term>Faux positifs</term>
<term>Femelle</term>
<term>Foie (anatomopathologie)</term>
<term>Humains</term>
<term>Mâle</term>
<term>Numération des plaquettes</term>
<term>Stéatose hépatique non alcoolique ()</term>
<term>Sujet âgé</term>
<term>Valeur prédictive des tests</term>
<term>Valeurs de référence</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Alanine Transaminase</term>
<term>Aspartate Aminotransferases</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Cirrhose du foie</term>
<term>Foie</term>
</keywords>
<keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Liver Cirrhosis</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Non-alcoholic Fatty Liver Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Liver Cirrhosis</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Cirrhose du foie</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Liver Cirrhosis</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Liver</term>
<term>Liver Cirrhosis</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Alanine transaminase</term>
<term>Aspartate aminotransferases</term>
<term>Cirrhose du foie</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Cirrhose du foie</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Age Factors</term>
<term>Aged</term>
<term>Area Under Curve</term>
<term>Biopsy</term>
<term>False Positive Reactions</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Platelet Count</term>
<term>Predictive Value of Tests</term>
<term>ROC Curve</term>
<term>Reference Values</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Aire sous la courbe</term>
<term>Biopsie</term>
<term>Courbe ROC</term>
<term>Facteurs de l'âge</term>
<term>Faux positifs</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Numération des plaquettes</term>
<term>Stéatose hépatique non alcoolique</term>
<term>Sujet âgé</term>
<term>Valeur prédictive des tests</term>
<term>Valeurs de référence</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>OBJECTIVES:</title>
<p>Non-invasive fibrosis scores are widely used to identify/exclude advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). However, these scores were principally developed and validated in patients aged between 35 and 65 years of age. The objective of this study was to assess the effect of age on the performance of non-invasive fibrosis tests in NAFLD.</p>
</sec>
<sec><title>METHODS:</title>
<p>Patients were recruited from European specialist hepatology clinics. The cohort was divided into five age-based groups: ≤35 (<italic>n</italic>
=74), 36–45 (<italic>n</italic>
=96), 46–55 (<italic>n</italic>
=197), 56–64 (<italic>n</italic>
=191), and ≥65 years (<italic>n</italic>
=76), and the performance of the aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, fibrosis 4 (FIB-4), and NAFLD fibrosis score (NFS) for advanced fibrosis (stage F3–F4) for each group was assessed using liver biopsy as the standard.</p>
</sec>
<sec><title>RESULTS:</title>
<p>Six hundred and thirty-four patients were included. The diagnostic accuracy of the AST/ALT ratio was lower than NFS and FIB-4 in all the age groups. The AST/ALT ratio, NFS, and FIB-4 score performed poorly for a diagnosis of advanced fibrosis in those aged ≤35 years (area under the receiver operating characteristic curves (AUROCs 0.52, 0.52, and 0.60, respectively). For all groups >35 years, AUROCs for advanced fibrosis were similar for the NFS and FIB-4 score (range 0.77–0.84). However, the specificity for advanced fibrosis using the FIB-4 and NFS declined with age, becoming unacceptably low in those aged ≥65 years (35% for FIB-4 and 20% for NFS). New cutoffs were derived (and validated) for those aged ≥65 years, which improved specificity to 70% without adversely affecting sensitivity (FIB-4 2.0, sensitivity 77% NFS 0.12, sensitivity 80%).</p>
</sec>
<sec><title>CONCLUSIONS:</title>
<p>The NFS and FIB-4 scores have similar accuracy for advanced fibrosis in patients aged >35 years. However, the specificity for advanced fibrosis is unacceptably low in patients aged ≥65 years, resulting in a high false positive rate. New thresholds for use in patients aged ≥65 years are proposed to address this issue.</p>
</sec>
</div>
</front>
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