Multiparametric ultrasound could be useful to identify high-risk NASH patients

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An ultrasound-based multiparametric model has shown promise in identifying patients with high-risk non-alcoholic steatohepatitis (NASH), thereby reducing the need for liver biopsy to determine whether a patient is a candidate for pharmacological treatment, according to a study. new study.

The secondary cross-sectional analysis, published in Radiologisty, included data collected between April 2017 and March 2019 on 111 patients at Tokyo University Medical Hospital with a clinical indication for liver biopsy in suspected non-alcoholic fatty liver disease (NAFLD) in order to derive a model identification of high-risk NASH patients. High-risk NASH was defined as substantial hepatic fibrosis (F2 or greater) and a NAFLD activity score (NAS) of 4 or greater.

The results were validated in a dataset from 102 patients in Korea with elevated levels of liver enzymes or clinically suspected diffuse liver disease, who were referred for liver biopsy between January 2018 and July 2019.

“In this study, we present a score that uses only American markers (hepatic stiffness, attenuation coefficient, and slope of dispersion) that can help identify high-risk non-alcoholic steatohepatitis (NASH) patients who are candidates for inclusion in clinical trials and for pharmacological therapy, ”wrote the authors, led by Katsutoshi Sugimoto, MD, PhD, of Tokyo Medical University, in the study. “Our choice of NASH with a non-alcoholic fatty liver disease activity score greater than or equal to 4 and a fibrosis score greater than or equal to F2 is based on the literature, including numerous therapeutic studies showing that the presence of a High necro-inflammatory activity is related to progressive injury and pharmacological response.

The combination of the three American parameters, which the study authors called the LAD-NASH score, had a positive predictive value of 86.5% (32 of 37) (95% CI: 71.2, 95.5 ) to identify patients with high risk NASH and a negative predictive value of 87.5% 87.5% (35 of 40) (95% CI: 73.2, 95.8) to exclude high risk NASH .

The area under the Receiver Operating Characteristic (AUC) was 0.86 in the Japan derivation group and 0.88 in the Korea validation group.

“Although the two study samples had significantly different distributions of fibrosis, steatosis, and lobular inflammation activity, as well as different incidence rates of high-risk NASH, the LAD-NASH score was found useful in both samples, providing similar levels of diagnostic performance, ”wrote the study authors.“ We therefore believe that the LAD-NASH score is useful in effectively identifying patients who are suitable for clinical trials and therapies. emerging and may also help reduce the number of unnecessary liver biopsies. “

The strengths of the study included the use of a prospective developmental population and a validation population from another country and the use of American standardized techniques and histopathological reference standards, Mark E. Lockhart, MD, MPH, of the University of Alabama, noted in an associated commentary report.

“Using the combined scoring system, the results of this research suggest that 59% of liver biopsies could have been avoided and this represents a higher level of performance than the previously published Fibroscan-AST algorithm,” Lockhart wrote.

Limitations include the fact that the LAD-NASH score requires a specific US scanner, trained personnel, and a complicated equation.

Larger multicenter studies are needed to validate the results.

“(We) believe that using the model combining the attenuation coefficient, dispersion slope and hepatic stiffness for the identification of the non-alcoholic steatohepatitis (LAD-NASH) score could lead to a more efficient identification of patients. patients with progressive nonalcoholic steatohepatitis who should be considered for further treatment and the LAD-NASH score should be applied to patients with suspected liver disease, including nonalcoholic fatty liver disease, ”the authors wrote. ‘study.


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