Serum Fibrosis Tests Guide Prognosis in Metabolic Dysfunction-Associated Fatty Liver Disease Patients Referred From Primary Care

Zhengyi Wang; Luis Calzadilla Bertot; Gary P Jeffrey; John Joseph; George Garas; Bastiaan de Boer; Yi Huang; Gerry MacQuillan; Michael Wallace; Briohny Smith; Leon A Adams

doi:10.1016/j.cgh.2021.09.040

Serum Fibrosis Tests Guide Prognosis in Metabolic Dysfunction-Associated Fatty Liver Disease Patients Referred From Primary Care

Clin Gastroenterol Hepatol. 2022 Sep;20(9):2041-2049.e5. doi: 10.1016/j.cgh.2021.09.040. Epub 2021 Oct 6.

Authors

Affiliations

¹ Medical School, The University of Western Australia, Perth, Western Australia, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
² Department of Biochemistry, PathWest Laboratory Medicine, Perth, Western Australia, Australia.
³ Anatomical Pathology, Pathwest, Perth, Western Australia, Australia.
⁴ Medical School, The University of Western Australia, Perth, Western Australia, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Electronic address: leon.adams@uwa.edu.au.

PMID: 34624564
DOI: 10.1016/j.cgh.2021.09.040

Abstract

Background & aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) is managed predominately in primary care, however, there is uncertainty regarding how to best identify patients for specialist referral. We examined the accuracy of noninvasive tests as screening tools for the prediction of outcomes in MAFLD patients referred from primary care.

Methods: Patients with MAFLD referred by primary care for specialist review to Sir Charles Gairdner Hospital (cohort 1, n = 626) or tertiary centers within Western Australia (cohort 2, n = 246) were examined. Hepascore, aspartate aminotransferase to platelet ratio, Fibrosis-4 (FIB-4), and nonalcoholic fatty liver disease fibrosis score performed at baseline were examined for their accuracy in predicting liver-related death (LRD), decompensation, and hepatocellular carcinoma. Outcomes were collected from hospital records and data linkage.

Results: The median follow-up period was 5.0 years (range, 0.1-13.0 y) and 3.8 years (range, 0.1-10.0 y) in cohorts 1 and 2, respectively. In both cohorts, Hepascore and FIB-4 had the highest area under the curve for the prediction of LRD (0.90-0.95 and 0.83-0.94, respectively), decompensation (0.86-0.91 and 0.86-0.87, respectively), and hepatocellular carcinoma (0.75-0.90 and 0.67-0.85, respectively). The sensitivity and negative predictive values were high (>90%) for Hepascore (cut-off value, 0.60), FIB-4 (cut-off value, 1.30), and nonalcoholic fatty liver disease fibrosis score (cut-off value, -1.455) for all outcomes in cohort 1, and for predicting LRD in cohort 2. Hepascore had the highest specificity, classified the greatest proportion of patients as low risk, and was favored by decision curve analysis as providing the greatest net benefit.

Conclusions: Serum noninvasive tests accurately stratify risk of liver-related outcomes in MAFLD patients and can be used as a screening tool for patients referred for specialist review by primary care.

Keywords: Cirrhosis; FIB-4; Hepascore; Hepatocellular Carcinoma; NAFLD; Noninvasive Testing; Outcomes.

MeSH terms

Aspartate Aminotransferases
Biopsy
Carcinoma, Hepatocellular*
Humans
Liver
Liver Cirrhosis
Liver Neoplasms*
Non-alcoholic Fatty Liver Disease*
Primary Health Care
Prognosis
Referral and Consultation
Severity of Illness Index

Substances

Aspartate Aminotransferases