Performance of Noninvasive Liver Fibrosis Scores in the Morbid Obese Patient, Same Scores but Different Thresholds
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ORIGINAL CONTRIBUTIONS
Performance of Noninvasive Liver Fibrosis Scores in the Morbid Obese Patient, Same Scores but Different Thresholds Diego Meneses 1 & Antonio Olveira 2 & Ramon Corripio 3 & María del Carmen Méndez 4 & Míriam Romero 2 & Isabel Calvo-Viñuelas 5 & Lucrecia Herranz 6 & David Vicent 7 & Ana Isabel de-Cos-Blanco 5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. It is a spectrum of progressive alterations, with the final step in liver fibrosis which carries a high burden of long-term mortality. The scores used to predict liver fibrosis are not properly validated in morbid obesity (MO). Our aim was to evaluate the performance of seven risk scores in bariatric surgery (BS) patients. Methods Cross-sectional analysis in a cohort of 60 patients with MO undergoing BS. Liver biopsy (LB) was taken and compared with fibrosis risk assessed by noninvasive scores: APRI, FIB-4, Forns, NFS (NAFLD fibrosis score), BARD, BAAT, and Hepamet. The area under the receiver operator characteristic curve (AUROC) and measures of diagnostic accuracy were calculated; performance of fibrosis scores was evaluated at standard threshold vs those suggested by ROC analysis. Results LB was available in 50 patients; 9 (18%) had significant fibrosis (F2-F4). The BARD and Forns scores best predicted the absence of fibrosis, both with negative predictive value (NPV) of 95.5%, with AUROC of 0.761 and 0.667, respectively. Modification of standard thresholds (2 for BARD and 6.9 for Forns) to those suggested by ROC analysis (3 and 3.6, respectively) improved performance of scores. Basal glucose, glycated hemoglobin (HbA1c), aspartate transaminase (AST), and gamma glutamyl transferase (GGT) were identified by logistic regression analysis as independent predictor of fibrosis. Conclusions Existing scoring systems are unable to stratify fibrosis risk in MO using established thresholds; its performance is improved if these cutoffs are modified. Keywords Nonalcoholic fatty liver disease . Fibrosis risk scores . APRI . BAAT . BARD . Forns . FIB-4 . Hepamet . NFS . Obesity . Bariatric surgery
* Diego Meneses [email protected] 1
Department of Endocrinology and Metabolism, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
2
Department of Gastroenterology, Liver Unit, Hospital Universitario La Paz, Madrid, Spain
3
Department of General Surgery, Metabolic Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
4
Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
5
Department of Endocrinology and Metabolism, Obesity Unit, Hospital Universitario La Paz, Madrid, Spain
6
Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Madrid, Spain
7
Instituto de Investigación Sanitaria del Hospital Universitario La Paz, Madrid, Spain
Introduction NAFLD is the most common cause of chronic liver disease in the developed world [1, 2]. It is considered the hepatic ma
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