Compensated Advanced Chronic Liver Disease in Nonalcoholic Fatty Liver Disease: Two-Step Strategy is Better than Baveno Criteria

• Published in: Digestive diseases and sciences Vol. 68; no. 3; pp. 1016 - 1025
• Main Authors: Elhence, Anshuman, Anand, Abhinav, Biswas, Sagnik, Vaishnav, Manas, Yadav, Rajni, Das, Prasenjit, Panwar, Rajesh, Agarwal, Sandeep, Gamanagatti, Shivanand, Kumar, Ramesh, Shalimar
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2023; Springer; Springer Nature B.V
• Subjects: Antibodies; Antigens; Ascites; Aspartate; Biochemistry; Biopsy; Blood platelets; Body mass index; Comparative analysis; Development and progression; Diabetes; Elasticity Imaging Techniques; Esophageal and Gastric Varices - complications; Evaluation; Fatty liver; Gastroenterology; Gastrointestinal surgery; Hepatitis; Hepatology; Humans; Hypertension; Hypertension, Portal - complications; Lipoproteins; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - diagnostic imaging; Liver diseases; Medicine; Medicine & Public Health; Metabolic syndrome; Metabolism; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Oncology; Original Article; Phosphatase; Retrospective Studies; Transplant Surgery; Values; MAFLD; Metabolic syndrome; Decompensation; Portal hypertension; Fibrosis
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-022-07579-5

Background
Advanced fibrosis and cirrhosis (compensated advanced chronic liver disease [cACLD]) are clinically indistinguishable and increase risk of developing clinically significant portal hypertension. Baveno VII recommends using elastography to rule out and diagnose cACLD with liver stiffness measurement (LSM) cut-offs of 10/15 kPa.
Methods
In a retrospective analysis of 330 nonalcoholic fatty liver disease (NAFLD) patients, performance of the Baveno VII cut-offs for diagnosing cACLD was compared with newly suggested lower cut-offs (8/12 kPa). A model for detecting cACLD among those with LSM between 8 and 12 kPa was developed and compared with recently published models.
Results
Seventy (21.2%) of the 330 NAFLD patients had biopsy-proven cACLD. The Baveno VII cut-offs (10/15 kPa) had a lower sensitivity of 72.8% (60.9–82.8%) and a specificity of 93.4% (89.7–96.1%). Sensitivity and specificity of lower cut-offs (8/12 kPa) were 91.4% (82.3–96.8%) and 88.5% (83.9–92.1%), respectively. Modeling based on the presence of diabetes (odds ratio [OR] 3.625[1.161–11.320], p = 0.027) and serum aspartate aminotransferase (AST) levels (OR 1.636[1.098–2.436], p = 0.015) correctly identified 75.7% of patients with LSM between 8 and 12 kPa. Our model performed best with an area under receiver operator curve (AUROC) of 0.725 (95%CI 0.609–0.822), compared to Papatheodoridi (AUROC 0.626, CI 0.506–.736) and Zhou (AUROC 0.523, CI 0.403–0.640) models. A two-step strategy comprising application of lower LSM cut-offs followed by the predictive model correctly identified the presence of cACLD in 83% of the patients as compared to 75% by the Baveno VII cut-offs.
Conclusion
A two-step strategy employing lower LSM cut-offs and modeling based on diabetes and AST levels outperforms Baveno VII cut-offs for identifying cACLD in NAFLD patients.