Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease.

Staufer, Katharina; Halilbasic, Emina; Spindelboeck, Walter; Eilenberg, Magdalena; Prager, Gerhard; Stadlbauer, Vanessa; Posch, Andreas; Munda, Petra; Marculescu, Rodrig; Obermayer-Pietsch, Barbara; Stift, Judith; Lackner, Carolin; Trauner, Michael; Stauber, Rudolf E (2019). Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease. United european gastroenterology journal, 7(8), pp. 1113-1123. Sage 10.1177/2050640619865133

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Background In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment. Objective To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH). Methods We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeterV2G, FibroMeterV3G, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4). Results Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeterV2G (AUROC 0.86, 0.88, 0.89), FibroMeterV3G (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79). Conclusion Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Staufer, Katharina


600 Technology > 610 Medicine & health








Lilian Karin Smith-Wirth

Date Deposited:

05 Feb 2020 10:16

Last Modified:

05 Feb 2020 10:16

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Enhanced liver fibrosis score FibroMeter NAFLD fibrosis score fibrosis-4 index liver stiffness measurement vibration-controlled transient elastography





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