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Performance of biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in patients with severe obesity: meta analysis of individual patient data.

Poynard T, Lassailly G, Diaz E, Clement K, Caïazzo R, Tordjman J, Munteanu M, Perazzo H, Demol B, Callafe R, Pattou F, Charlotte F, Bedossa P, Mathurin P, Ratziu V, FLIP consorti - PLoS ONE (2012)

Bottom Line: Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect.Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63-0.79; P<0.0001); SteatoTest = 0.71 (0.66-0.75; P<0.0001); and ActiTest = 0.74 (0.68-0.79; P<0.0001).Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.

View Article: PubMed Central - PubMed

Affiliation: APHP UPMC Liver Center, Paris, France. tpoynard@teaser.fr

ABSTRACT

Background: Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.

Methods: 494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.

Results: Prevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance)  =  0.85 (0.83-0.87; P<0.0001); SteatoTest for advanced steatosis = 0.80 (0.79-0.83); and ActiTest for steato-hepatitis = 0.84 (0.82-0.86; P<0.0001). Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63-0.79; P<0.0001); SteatoTest = 0.71 (0.66-0.75; P<0.0001); and ActiTest = 0.74 (0.68-0.79; P<0.0001). Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.

Conclusion: In patients with severe obesity, a significant diagnostic performance of FibroTest, SteatoTest and ActiTest was observed for liver lesions.

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Related in: MedlinePlus

Meta-analyses of 3 studies of biomarkers accuracy (Obuchowski measure: weighted area under the ROC curve [wAUROC]) for the diagnostic of liver injury in patients with severe obesity.FibroTest for the diagnosis of advanced fibrosis (at least equivalent to METAVIR score F2). SteatoTest for the diagnosis of advanced steatosis (>30% steatosis). ActiTest for the diagnosis of NASH (NAS score >4). The horizontal lines indicate the 95% confidence interval for the mean difference between between test's wAUROCs and random (0.500). The vertical lines indicate the equivalence line (0% difference). Positive differences indicate a difference in favor of test). When the horizontal line crosses the vertical line, there is no significant difference. Ave = Average of AUROCs.
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pone-0030325-g003: Meta-analyses of 3 studies of biomarkers accuracy (Obuchowski measure: weighted area under the ROC curve [wAUROC]) for the diagnostic of liver injury in patients with severe obesity.FibroTest for the diagnosis of advanced fibrosis (at least equivalent to METAVIR score F2). SteatoTest for the diagnosis of advanced steatosis (>30% steatosis). ActiTest for the diagnosis of NASH (NAS score >4). The horizontal lines indicate the 95% confidence interval for the mean difference between between test's wAUROCs and random (0.500). The vertical lines indicate the equivalence line (0% difference). Positive differences indicate a difference in favor of test). When the horizontal line crosses the vertical line, there is no significant difference. Ave = Average of AUROCs.

Mentions: The pooled results of wAUROCs are shown in Figure 3 for FT and advanced fibrosis, for ST and advanced steatosis and for AT and NASH. For FT the mean wAUROC was 0.83 (0.78–0.88; P<0.0001), with a significant heterogeneity (Q = 11.1 P = 0.004). For ST the mean wAUROC was 0.81 (0.78–0.83; P<0.0001), without significant heterogeneity (Q = 0.8 P = 0.67). For AT the mean wAUROC was 0.84 (0.79–0.88; P<0.001), without significant heterogeneity (Q = 5.9 P = 0.051).


Performance of biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in patients with severe obesity: meta analysis of individual patient data.

Poynard T, Lassailly G, Diaz E, Clement K, Caïazzo R, Tordjman J, Munteanu M, Perazzo H, Demol B, Callafe R, Pattou F, Charlotte F, Bedossa P, Mathurin P, Ratziu V, FLIP consorti - PLoS ONE (2012)

Meta-analyses of 3 studies of biomarkers accuracy (Obuchowski measure: weighted area under the ROC curve [wAUROC]) for the diagnostic of liver injury in patients with severe obesity.FibroTest for the diagnosis of advanced fibrosis (at least equivalent to METAVIR score F2). SteatoTest for the diagnosis of advanced steatosis (>30% steatosis). ActiTest for the diagnosis of NASH (NAS score >4). The horizontal lines indicate the 95% confidence interval for the mean difference between between test's wAUROCs and random (0.500). The vertical lines indicate the equivalence line (0% difference). Positive differences indicate a difference in favor of test). When the horizontal line crosses the vertical line, there is no significant difference. Ave = Average of AUROCs.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3303768&req=5

pone-0030325-g003: Meta-analyses of 3 studies of biomarkers accuracy (Obuchowski measure: weighted area under the ROC curve [wAUROC]) for the diagnostic of liver injury in patients with severe obesity.FibroTest for the diagnosis of advanced fibrosis (at least equivalent to METAVIR score F2). SteatoTest for the diagnosis of advanced steatosis (>30% steatosis). ActiTest for the diagnosis of NASH (NAS score >4). The horizontal lines indicate the 95% confidence interval for the mean difference between between test's wAUROCs and random (0.500). The vertical lines indicate the equivalence line (0% difference). Positive differences indicate a difference in favor of test). When the horizontal line crosses the vertical line, there is no significant difference. Ave = Average of AUROCs.
Mentions: The pooled results of wAUROCs are shown in Figure 3 for FT and advanced fibrosis, for ST and advanced steatosis and for AT and NASH. For FT the mean wAUROC was 0.83 (0.78–0.88; P<0.0001), with a significant heterogeneity (Q = 11.1 P = 0.004). For ST the mean wAUROC was 0.81 (0.78–0.83; P<0.0001), without significant heterogeneity (Q = 0.8 P = 0.67). For AT the mean wAUROC was 0.84 (0.79–0.88; P<0.001), without significant heterogeneity (Q = 5.9 P = 0.051).

Bottom Line: Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect.Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63-0.79; P<0.0001); SteatoTest = 0.71 (0.66-0.75; P<0.0001); and ActiTest = 0.74 (0.68-0.79; P<0.0001).Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.

View Article: PubMed Central - PubMed

Affiliation: APHP UPMC Liver Center, Paris, France. tpoynard@teaser.fr

ABSTRACT

Background: Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions in patients with severe obesity. The aim of this study was to perform an overview of 3 studies which assessed the performance of non-invasive markers of fibrosis (FibroTest), steatosis (SteatoTest) and steato-hepatitis (NashTest, ActiTest) in these patients.

Methods: 494 patients with interpretable biopsy and biomarkers using of three prospective cohorts of patients with severe obesity (BMI >35 kg/m2) were included. Histology (NAS score) and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (wAUROC Obuchowski method) was used to prevent multiple testing and spectrum effect. Two meta-analyses were performed; one used the individual patient, and the other a classical meta-analysis.

Results: Prevalence of advanced fibrosis (bridging) was 9.9%, advanced steatosis (>33%) 54.2%, and steato-hepatitis (NAS score >4) 17.2%. The mean wAUROCs were: FibroTest for advanced fibrosis (95%CI; significance)  =  0.85 (0.83-0.87; P<0.0001); SteatoTest for advanced steatosis = 0.80 (0.79-0.83); and ActiTest for steato-hepatitis = 0.84 (0.82-0.86; P<0.0001). Using the classical meta-analysis (random effect model) the mean AUROCs were: FibroTest = 0.72 (0.63-0.79; P<0.0001); SteatoTest = 0.71 (0.66-0.75; P<0.0001); and ActiTest = 0.74 (0.68-0.79; P<0.0001). Despite more metabolic risk factors in one cohort, results were similar according to gender, presence of diabetes and between the 3 cohorts.

Conclusion: In patients with severe obesity, a significant diagnostic performance of FibroTest, SteatoTest and ActiTest was observed for liver lesions.

Show MeSH
Related in: MedlinePlus