Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis
Identifieur interne : 003C87 ( Ncbi/Merge ); précédent : 003C86; suivant : 003C88Age 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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PMC:5418560Le document en format XML
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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>
</affiliation>
<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>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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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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<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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<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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, Sevilla,<country>Spain</country>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Allison, Mike" sort="Allison, Mike" uniqKey="Allison M" first="Mike" last="Allison">Mike Allison</name>
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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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, Sao Paulo,<country>Brazil</country>
</nlm:aff>
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<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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</nlm:aff>
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</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<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>
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<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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</TEI>
<double pmid="27725647"><pmc><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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>
</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="Hardy, Tim" sort="Hardy, Tim" uniqKey="Hardy T" first="Tim" last="Hardy">Tim Hardy</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="Dufour, Jean Francois" sort="Dufour, Jean Francois" uniqKey="Dufour J" first="Jean-Francois" last="Dufour">Jean-Francois Dufour</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"><institution>University Clinic for Visceral Surgery and Medicine, University of Berne</institution>
, Berne,<country>Switzerland</country>
</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Petta, Salvatore" sort="Petta, Salvatore" uniqKey="Petta S" first="Salvatore" last="Petta">Salvatore Petta</name>
<affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo</institution>
, Palermo,<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="Romero Gomez, Manuel" sort="Romero Gomez, Manuel" uniqKey="Romero Gomez M" first="Manuel" last="Romero-Gomez">Manuel Romero-Gomez</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío</institution>
, Sevilla,<country>Spain</country>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Allison, Mike" sort="Allison, Mike" uniqKey="Allison M" first="Mike" last="Allison">Mike Allison</name>
<affiliation wicri:level="1"><nlm:aff id="aff6"><institution>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre</institution>
, Cambridge,<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="Oliveira, Claudia P" sort="Oliveira, Claudia P" uniqKey="Oliveira C" first="Claudia P" last="Oliveira">Claudia P. Oliveira</name>
<affiliation wicri:level="1"><nlm:aff id="aff7"><institution>Department of Gastroenterology, University of Sao Paulo School of Medicine</institution>
, Sao Paulo,<country>Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Francque, Sven" sort="Francque, Sven" uniqKey="Francque S" first="Sven" last="Francque">Sven Francque</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><institution>Department of Gastroenterology Hepatology, Antwerp University Hospital</institution>
, Antwerp,<country>Belgium</country>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Van Gaal, Luc" sort="Van Gaal, Luc" uniqKey="Van Gaal L" first="Luc" last="Van Gaal">Luc Van Gaal</name>
<affiliation wicri:level="1"><nlm:aff id="aff9"><institution>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital</institution>
, Antwerp,<country>Belgium</country>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Schattenberg, Jorn M" sort="Schattenberg, Jorn M" uniqKey="Schattenberg J" first="Jörn M" last="Schattenberg">Jörn M. Schattenberg</name>
<affiliation wicri:level="1"><nlm:aff id="aff10"><institution>Department of Medicine, University Hospital</institution>
, Mainz,<country>Germany</country>
</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Tiniakos, Dina" sort="Tiniakos, Dina" uniqKey="Tiniakos D" first="Dina" last="Tiniakos">Dina Tiniakos</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="Burt, Alastair" sort="Burt, Alastair" uniqKey="Burt A" first="Alastair" last="Burt">Alastair Burt</name>
<affiliation wicri:level="1"><nlm:aff id="aff11"><institution>School of Medicine, University of Adelaide</institution>
, Adelaide,<country>Australia</country>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bugianesi, Elisabetta" sort="Bugianesi, Elisabetta" uniqKey="Bugianesi E" first="Elisabetta" last="Bugianesi">Elisabetta Bugianesi</name>
<affiliation wicri:level="1"><nlm:aff id="aff12"><institution>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin</institution>
, 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>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">27725647</idno>
<idno type="pmc">5418560</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418560</idno>
<idno type="RBID">PMC:5418560</idno>
<idno type="doi">10.1038/ajg.2016.453</idno>
<date when="2016">2016</date>
<idno type="wicri:Area/Pmc/Corpus">000701</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000701</idno>
<idno type="wicri:Area/Pmc/Curation">000700</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000700</idno>
<idno type="wicri:Area/Pmc/Checkpoint">000B42</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000B42</idno>
</publicationStmt>
<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>
</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="Hardy, Tim" sort="Hardy, Tim" uniqKey="Hardy T" first="Tim" last="Hardy">Tim Hardy</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="Dufour, Jean Francois" sort="Dufour, Jean Francois" uniqKey="Dufour J" first="Jean-Francois" last="Dufour">Jean-Francois Dufour</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"><institution>University Clinic for Visceral Surgery and Medicine, University of Berne</institution>
, Berne,<country>Switzerland</country>
</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Petta, Salvatore" sort="Petta, Salvatore" uniqKey="Petta S" first="Salvatore" last="Petta">Salvatore Petta</name>
<affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo</institution>
, Palermo,<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="Romero Gomez, Manuel" sort="Romero Gomez, Manuel" uniqKey="Romero Gomez M" first="Manuel" last="Romero-Gomez">Manuel Romero-Gomez</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío</institution>
, Sevilla,<country>Spain</country>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Allison, Mike" sort="Allison, Mike" uniqKey="Allison M" first="Mike" last="Allison">Mike Allison</name>
<affiliation wicri:level="1"><nlm:aff id="aff6"><institution>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre</institution>
, Cambridge,<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="Oliveira, Claudia P" sort="Oliveira, Claudia P" uniqKey="Oliveira C" first="Claudia P" last="Oliveira">Claudia P. Oliveira</name>
<affiliation wicri:level="1"><nlm:aff id="aff7"><institution>Department of Gastroenterology, University of Sao Paulo School of Medicine</institution>
, Sao Paulo,<country>Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Francque, Sven" sort="Francque, Sven" uniqKey="Francque S" first="Sven" last="Francque">Sven Francque</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><institution>Department of Gastroenterology Hepatology, Antwerp University Hospital</institution>
, Antwerp,<country>Belgium</country>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Van Gaal, Luc" sort="Van Gaal, Luc" uniqKey="Van Gaal L" first="Luc" last="Van Gaal">Luc Van Gaal</name>
<affiliation wicri:level="1"><nlm:aff id="aff9"><institution>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital</institution>
, Antwerp,<country>Belgium</country>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Schattenberg, Jorn M" sort="Schattenberg, Jorn M" uniqKey="Schattenberg J" first="Jörn M" last="Schattenberg">Jörn M. Schattenberg</name>
<affiliation wicri:level="1"><nlm:aff id="aff10"><institution>Department of Medicine, University Hospital</institution>
, Mainz,<country>Germany</country>
</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Tiniakos, Dina" sort="Tiniakos, Dina" uniqKey="Tiniakos D" first="Dina" last="Tiniakos">Dina Tiniakos</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="Burt, Alastair" sort="Burt, Alastair" uniqKey="Burt A" first="Alastair" last="Burt">Alastair Burt</name>
<affiliation wicri:level="1"><nlm:aff id="aff11"><institution>School of Medicine, University of Adelaide</institution>
, Adelaide,<country>Australia</country>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bugianesi, Elisabetta" sort="Bugianesi, Elisabetta" uniqKey="Bugianesi E" first="Elisabetta" last="Bugianesi">Elisabetta Bugianesi</name>
<affiliation wicri:level="1"><nlm:aff id="aff12"><institution>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin</institution>
, 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></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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</pmc>
<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hardy, Tim" sort="Hardy, Tim" uniqKey="Hardy T" first="Tim" last="Hardy">Tim Hardy</name>
<affiliation wicri:level="1"><nlm:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dufour, Jean Francois" sort="Dufour, Jean Francois" uniqKey="Dufour J" first="Jean-Francois" last="Dufour">Jean-Francois Dufour</name>
<affiliation wicri:level="3"><nlm:affiliation>University Clinic for Visceral Surgery and Medicine, University of Berne, Berne, Switzerland.</nlm:affiliation>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>University Clinic for Visceral Surgery and Medicine, University of Berne, Berne</wicri:regionArea>
<placeName><settlement type="city">Berne</settlement>
<region type="région" nuts="3">Canton de Berne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Petta, Salvatore" sort="Petta, Salvatore" uniqKey="Petta S" first="Salvatore" last="Petta">Salvatore Petta</name>
<affiliation wicri:level="1"><nlm:affiliation>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy.</nlm:affiliation>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Palermo</wicri:regionArea>
<wicri:noRegion>Palermo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Romero Gomez, Manuel" sort="Romero Gomez, Manuel" uniqKey="Romero Gomez M" first="Manuel" last="Romero-Gomez">Manuel Romero-Gomez</name>
<affiliation wicri:level="1"><nlm:affiliation>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío, Sevilla, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío, Sevilla</wicri:regionArea>
<wicri:noRegion>Sevilla</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Allison, Mike" sort="Allison, Mike" uniqKey="Allison M" first="Mike" last="Allison">Mike Allison</name>
<affiliation wicri:level="1"><nlm:affiliation>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge</wicri:regionArea>
<wicri:noRegion>Cambridge</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Oliveira, Claudia P" sort="Oliveira, Claudia P" uniqKey="Oliveira C" first="Claudia P" last="Oliveira">Claudia P. Oliveira</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.</nlm:affiliation>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo</wicri:regionArea>
<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Francque, Sven" sort="Francque, Sven" uniqKey="Francque S" first="Sven" last="Francque">Sven Francque</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp</wicri:regionArea>
<wicri:noRegion>Antwerp</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Van Gaal, Luc" sort="Van Gaal, Luc" uniqKey="Van Gaal L" first="Luc" last="Van Gaal">Luc Van Gaal</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp</wicri:regionArea>
<wicri:noRegion>Antwerp</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Schattenberg, Jorn M" sort="Schattenberg, Jorn M" uniqKey="Schattenberg J" first="Jörn M" last="Schattenberg">Jörn M. Schattenberg</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, University Hospital, Mainz, Germany.</nlm:affiliation>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Medicine, University Hospital, Mainz</wicri:regionArea>
<placeName><region type="land" nuts="2">Rhénanie-Palatinat</region>
<settlement type="city">Mayence</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Tiniakos, Dina" sort="Tiniakos, Dina" uniqKey="Tiniakos D" first="Dina" last="Tiniakos">Dina Tiniakos</name>
<affiliation wicri:level="1"><nlm:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Burt, Alastair" sort="Burt, Alastair" uniqKey="Burt A" first="Alastair" last="Burt">Alastair Burt</name>
<affiliation wicri:level="1"><nlm:affiliation>School of Medicine, University of Adelaide, Adelaide, Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>School of Medicine, University of Adelaide, Adelaide</wicri:regionArea>
<wicri:noRegion>Adelaide</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bugianesi, Elisabetta" sort="Bugianesi, Elisabetta" uniqKey="Bugianesi E" first="Elisabetta" last="Bugianesi">Elisabetta Bugianesi</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.</nlm:affiliation>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin</wicri:regionArea>
<placeName><settlement type="city">Turin</settlement>
<region type="région" nuts="2">Piémont</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ratziu, Vlad" sort="Ratziu, Vlad" uniqKey="Ratziu V" first="Vlad" last="Ratziu">Vlad Ratziu</name>
<affiliation wicri:level="3"><nlm:affiliation>Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PubMed</idno>
<date when="2017">2017</date>
<idno type="RBID">pubmed:27725647</idno>
<idno type="pmid">27725647</idno>
<idno type="doi">10.1038/ajg.2016.453</idno>
<idno type="wicri:Area/PubMed/Corpus">000D38</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000D38</idno>
<idno type="wicri:Area/PubMed/Curation">000D35</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000D35</idno>
<idno type="wicri:Area/PubMed/Checkpoint">000D35</idno>
<idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000D35</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en">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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hardy, Tim" sort="Hardy, Tim" uniqKey="Hardy T" first="Tim" last="Hardy">Tim Hardy</name>
<affiliation wicri:level="1"><nlm:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dufour, Jean Francois" sort="Dufour, Jean Francois" uniqKey="Dufour J" first="Jean-Francois" last="Dufour">Jean-Francois Dufour</name>
<affiliation wicri:level="3"><nlm:affiliation>University Clinic for Visceral Surgery and Medicine, University of Berne, Berne, Switzerland.</nlm:affiliation>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>University Clinic for Visceral Surgery and Medicine, University of Berne, Berne</wicri:regionArea>
<placeName><settlement type="city">Berne</settlement>
<region type="région" nuts="3">Canton de Berne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Petta, Salvatore" sort="Petta, Salvatore" uniqKey="Petta S" first="Salvatore" last="Petta">Salvatore Petta</name>
<affiliation wicri:level="1"><nlm:affiliation>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy.</nlm:affiliation>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Palermo</wicri:regionArea>
<wicri:noRegion>Palermo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Romero Gomez, Manuel" sort="Romero Gomez, Manuel" uniqKey="Romero Gomez M" first="Manuel" last="Romero-Gomez">Manuel Romero-Gomez</name>
<affiliation wicri:level="1"><nlm:affiliation>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío, Sevilla, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>UCM Digestive Diseases, Hospital Universitario Virgen Macarena-Virgen del Rocío, Sevilla</wicri:regionArea>
<wicri:noRegion>Sevilla</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Allison, Mike" sort="Allison, Mike" uniqKey="Allison M" first="Mike" last="Allison">Mike Allison</name>
<affiliation wicri:level="1"><nlm:affiliation>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge</wicri:regionArea>
<wicri:noRegion>Cambridge</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Oliveira, Claudia P" sort="Oliveira, Claudia P" uniqKey="Oliveira C" first="Claudia P" last="Oliveira">Claudia P. Oliveira</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.</nlm:affiliation>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo</wicri:regionArea>
<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Francque, Sven" sort="Francque, Sven" uniqKey="Francque S" first="Sven" last="Francque">Sven Francque</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp</wicri:regionArea>
<wicri:noRegion>Antwerp</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Van Gaal, Luc" sort="Van Gaal, Luc" uniqKey="Van Gaal L" first="Luc" last="Van Gaal">Luc Van Gaal</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp</wicri:regionArea>
<wicri:noRegion>Antwerp</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Schattenberg, Jorn M" sort="Schattenberg, Jorn M" uniqKey="Schattenberg J" first="Jörn M" last="Schattenberg">Jörn M. Schattenberg</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, University Hospital, Mainz, Germany.</nlm:affiliation>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Medicine, University Hospital, Mainz</wicri:regionArea>
<placeName><region type="land" nuts="2">Rhénanie-Palatinat</region>
<settlement type="city">Mayence</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Tiniakos, Dina" sort="Tiniakos, Dina" uniqKey="Tiniakos D" first="Dina" last="Tiniakos">Dina Tiniakos</name>
<affiliation wicri:level="1"><nlm:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Burt, Alastair" sort="Burt, Alastair" uniqKey="Burt A" first="Alastair" last="Burt">Alastair Burt</name>
<affiliation wicri:level="1"><nlm:affiliation>School of Medicine, University of Adelaide, Adelaide, Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>School of Medicine, University of Adelaide, Adelaide</wicri:regionArea>
<wicri:noRegion>Adelaide</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bugianesi, Elisabetta" sort="Bugianesi, Elisabetta" uniqKey="Bugianesi E" first="Elisabetta" last="Bugianesi">Elisabetta Bugianesi</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.</nlm:affiliation>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin</wicri:regionArea>
<placeName><settlement type="city">Turin</settlement>
<region type="région" nuts="2">Piémont</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ratziu, Vlad" sort="Ratziu, Vlad" uniqKey="Ratziu V" first="Vlad" last="Ratziu">Vlad Ratziu</name>
<affiliation wicri:level="3"><nlm:affiliation>Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</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:affiliation>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne</wicri:regionArea>
<wicri:noRegion>Newcastle upon Tyne</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">The American journal of gastroenterology</title>
<idno type="eISSN">1572-0241</idno>
<imprint><date when="2017" type="published">2017</date>
</imprint>
</series>
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<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>
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</teiHeader>
<front><div type="abstract" xml:lang="en">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.</div>
</front>
</TEI>
</pubmed>
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