NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.

<h4>Aims</h4>To develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease (NAFLD) derived from routinely obtained clinical and biochemical parameters.<h4>Methods</h4>267 consecutive patients with biopsy proven fatty liver or no...

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Autores principales: Münevver Demir, Sonja Lang, Martin Schlattjan, Uta Drebber, Inga Wedemeyer, Dirk Nierhoff, Ingrid Kaul, Jan Sowa, Ali Canbay, Ulrich Töx, Hans-Michael Steffen
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Publicado: Public Library of Science (PLoS) 2013
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spelling oai:doaj.org-article:0c5f33f797934c369e505e373d9cada52021-11-18T07:52:04ZNIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.1932-620310.1371/journal.pone.0058360https://doaj.org/article/0c5f33f797934c369e505e373d9cada52013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23555578/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Aims</h4>To develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease (NAFLD) derived from routinely obtained clinical and biochemical parameters.<h4>Methods</h4>267 consecutive patients with biopsy proven fatty liver or non-alcoholic steatohepatitis were randomly assigned to the estimation (2/3) or validation (1/3) group to develop a model for the prediction of advanced fibrosis. Univariate statistics were performed to compare patients with and without advanced fibrosis, and following a multivariate logistic regression analysis a new scoring system was constructed. This non-invasive Koeln-Essen-index (NIKEI) was validated and compared to the FIB-4 index by calculating the area under the receiver operating characteristic curve (AUC). We evaluated a stepwise combination of both scoring systems for the precise prediction of advanced fibrosis. To set in contrast, we additionally tested the diagnostic accuracy of the AST/ALT ratio, BARD score and the NAFLD fibrosis score in our cohort.<h4>Results</h4>Age, AST, AST/ALT ratio, and total bilirubin were identified as significant predictors of advanced fibrosis and used to construct the NIKEI with an AUC of 0.968 [0.937; 0.998] compared to 0.929 [0.869; 0.989] for the FIB-4 index. The absence of advanced fibrosis could be confirmed with excellent accuracy (99-100%). The positive predictive value of the FIB-4 index was higher (100% vs. 60%), however, the false negative rate was also high (33%). With a stepwise combination of both indices 82%-84% of biopsies would have been avoidable without a single misclassification. The AUROC for AST/ALT ratio, the NAFLD fibrosis score, and the BARD score were 0.81 (95% CI, 0.72-0.90), 0.96 (95% CI 0.92-0.99), and 0.67 (95% CI 0.55-0.78), respectively.<h4>Conclusion</h4>The NIKEI can reliably exclude advanced fibrosis in subjects with NAFLD. In combination with the FIB-4 index misclassification with inadequate clinical management can be avoided while the need for liver biopsies can be reduced.Münevver DemirSonja LangMartin SchlattjanUta DrebberInga WedemeyerDirk NierhoffIngrid KaulJan SowaAli CanbayUlrich TöxHans-Michael SteffenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e58360 (2013)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Münevver Demir
Sonja Lang
Martin Schlattjan
Uta Drebber
Inga Wedemeyer
Dirk Nierhoff
Ingrid Kaul
Jan Sowa
Ali Canbay
Ulrich Töx
Hans-Michael Steffen
NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
description <h4>Aims</h4>To develop, validate and compare a non-invasive fibrosis scoring system for non-alcoholic fatty liver disease (NAFLD) derived from routinely obtained clinical and biochemical parameters.<h4>Methods</h4>267 consecutive patients with biopsy proven fatty liver or non-alcoholic steatohepatitis were randomly assigned to the estimation (2/3) or validation (1/3) group to develop a model for the prediction of advanced fibrosis. Univariate statistics were performed to compare patients with and without advanced fibrosis, and following a multivariate logistic regression analysis a new scoring system was constructed. This non-invasive Koeln-Essen-index (NIKEI) was validated and compared to the FIB-4 index by calculating the area under the receiver operating characteristic curve (AUC). We evaluated a stepwise combination of both scoring systems for the precise prediction of advanced fibrosis. To set in contrast, we additionally tested the diagnostic accuracy of the AST/ALT ratio, BARD score and the NAFLD fibrosis score in our cohort.<h4>Results</h4>Age, AST, AST/ALT ratio, and total bilirubin were identified as significant predictors of advanced fibrosis and used to construct the NIKEI with an AUC of 0.968 [0.937; 0.998] compared to 0.929 [0.869; 0.989] for the FIB-4 index. The absence of advanced fibrosis could be confirmed with excellent accuracy (99-100%). The positive predictive value of the FIB-4 index was higher (100% vs. 60%), however, the false negative rate was also high (33%). With a stepwise combination of both indices 82%-84% of biopsies would have been avoidable without a single misclassification. The AUROC for AST/ALT ratio, the NAFLD fibrosis score, and the BARD score were 0.81 (95% CI, 0.72-0.90), 0.96 (95% CI 0.92-0.99), and 0.67 (95% CI 0.55-0.78), respectively.<h4>Conclusion</h4>The NIKEI can reliably exclude advanced fibrosis in subjects with NAFLD. In combination with the FIB-4 index misclassification with inadequate clinical management can be avoided while the need for liver biopsies can be reduced.
format article
author Münevver Demir
Sonja Lang
Martin Schlattjan
Uta Drebber
Inga Wedemeyer
Dirk Nierhoff
Ingrid Kaul
Jan Sowa
Ali Canbay
Ulrich Töx
Hans-Michael Steffen
author_facet Münevver Demir
Sonja Lang
Martin Schlattjan
Uta Drebber
Inga Wedemeyer
Dirk Nierhoff
Ingrid Kaul
Jan Sowa
Ali Canbay
Ulrich Töx
Hans-Michael Steffen
author_sort Münevver Demir
title NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
title_short NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
title_full NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
title_fullStr NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
title_full_unstemmed NIKEI: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD.
title_sort nikei: a new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with nafld.
publisher Public Library of Science (PLoS)
publishDate 2013
url https://doaj.org/article/0c5f33f797934c369e505e373d9cada5
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