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Panminerva Medica 2021 December;63(4):508-18

DOI: 10.23736/S0031-0808.20.04171-3


lingua: Inglese

Noninvasive biomarkers in predicting nonalcoholic steatohepatitis and assessing liver fibrosis: systematic review and meta-analysis

Abdulrahman ISMAIEL 1, Daniel-Corneliu LEUCUTA 2 , Stefan-Lucian POPA 1, Sharmila FAGOONEE 3, Rinaldo PELLICANO 4, Ludovico ABENAVOLI 5, Dan L. DUMITRASCU 1

1 Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 2 Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 3 Institute for Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy; 4 Unit of Gastroenterology, Molinette Hospital, Turin, Italy; 5 Department of Health Sciences, Magna Graecia University, Catanzaro, Italy

INTRODUCTION: Nonalcoholic steatohepatitis (NASH) is characterized by hepatic steatosis with inflammation, ballooned hepatocytes and possible fibrosis, which may progress to liver cirrhosis. Although liver biopsy, remains the diagnostic gold standard of NASH, several noninvasive biomarkers have been studied, to avoid the need for this invasive procedure. We performed a systematic review with meta-analysis to evaluate the accuracy of several noninvasive biomarkers in predicting NASH and assessing liver fibrosis in NASH patients.
EVIDENCE ACQUISITION: An electronic search on PubMed and Embase was systematically performed. The principal summary outcome was the area under the curve (AUC), assessing the accuracy of NashTest, BARD (Body Mass Index, AST/ALT ratio, diabetes) score, NAFLD fibrosis score (NFS), APRI (aspartate aminotransferase-to-Platelet Ratio Index), and Fibrosis-4 (FIB-4) Index in predicting NASH and assessing liver fibrosis.
EVIDENCE SYNTHESIS: Thirteen studies involving 6557 adult patients were included in the qualitative assessment of this review, out of which, six studies were included in the quantitative assessment. Prediction of NASH was evaluated better using NFS (AUC of 0.687) and FIB-4 (AUC of 0.729). Fibrosis stages 0 vs. 1-4 was diagnosed better using NFS (AUC of 0.718) and FIB-4 (AUC of 0.723). Advanced fibrosis was assessed better by BARD (AUC of 0.673), APRI (AUC of 0.762), NFS (AUC of 0.787) and FIB-4 (AUC of 0.821).
CONCLUSIONS: FIB-4 predicted NASH and quantified liver fibrosis, stages 0 vs. 1-4 more precisely compared to NFS, APRI, and BARD. However, considering that methodological quality of the assessed studies is limited, the results should be considered with caution.

KEY WORDS: Liver diseases; Biomarkers; Systematic review

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