Non-alcoholic fatty liver disease (NAFLD) affects 15–40% of the general population. Some patients have non-alcoholic steatohepatitis (NASH) and progressive fibrosis, and would be candidates for monitoring and treatment.
Dr Wong and colleagues from China reviewed current literature on the use of non-invasive tests to assess the severity of NAFLD.
Systematic literature searching identified studies evaluating non-invasive tests of NASH and fibrosis using liver biopsy as the reference standard.
The research team performed meta-analysis for areas with adequate number of publications.
|Liver stiffness measurement often fails in obese patients|
|Alimentary Pharmacology & Therapeutics|
Serum tests and physical measurements like transient elastography (TE) have high negative predictive value (NPV) in excluding advanced fibrosis in NAFLD patients.
The NAFLD fibrosis score comprises of 6 routine clinical parameters and has been endorsed by current American guidelines as a screening test to exclude low-risk individuals.
The pooled sensitivities and specificities for TE to diagnose F ≥ 2, F ≥ 3 and F4 disease were 79% and 75%, 85% and 85%, and 92% and 92% respectively.
Liver stiffness measurement often fails in obese patients, but the success rate can be improved with the use of the XL probe.
The team reported that a number of biomarkers have been developed for the diagnosis of NASH, but few were independently validated.
Serum/plasma cytokeratin-18 fragments have been most extensively evaluated, and have a pooled sensitivity of 66% and specificity of 82% in diagnosing NASH.
Dr Wong's team concludes, "Current non-invasive tests are accurate in excluding advanced fibrosis in NAFLD patients, and may be used for initial assessment."
"Further development and evaluation of NASH biomarkers are needed."