Noninvasive tests can predict liver complications in NAFLD patients

Blood test fibrosis-4 (FIB4) and vibration-controlled transient elastography (VCTE) can accurately classify patients with nonalcoholic fatty liver disease (NAFLD) who are at risk of liver-related events (LREs), suggests a recent study.

“These noninvasive tests are alternatives to liver biopsy for the identification of patients in need of specialized management,” the authors said.

This multicentre cohort study included 1,057 patients with NAFLD and baseline FIB4 and VCTE. Of these, 594 had a baseline liver biopsy. The occurrence of LREs, a composite endpoint combining cirrhosis complications and/or hepatocellular carcinoma, was the primary outcome during follow-up. The authors evaluated the discriminative ability of tests using Harrell’s C-index.

FIB4 and VCTE demonstrated good accuracy in predicting LRE, with Harrell’s C-indexes >0.80 (0.817 vs 0.878, respectively; p=0.059).

In the biopsy subgroup, Harrell’s C-indexes of histological fibrosis staging and VCTE did not differ significantly (0.932 vs 0.881, respectively; p=0.164), and both markedly outperformed FIB4 for the prediction of LREs. Of note, FIB4 and VCTE independently predicted LREs in the whole study cohort.

The stepwise FIB4-VCTE algorithm accurately stratified the risk of LREs. Patients with “FIB4 ≥1.30 then VCTE <8.0 kPa” showed a similar LRE risk compared to those with “FIB4 <1.30” (adjusted hazard ratio [aHR], 1.3, 95 percent confidence interval [CI], 0.3‒6.8), while LRE risk substantially rose in patients with “FIB4 ≥1.30 then VCTE 8.0-12.0 kPa” (aHR, 3.8, 95 percent CI, 1.3–10.9) and even more in those with “FIB4 ≥1.30 then VCTE >12.0 kPa” (aHR, 12.4, 95 percent CI, 5.1–30.2).

“Our results show that the blood test FIB4 and transient elastography stratify the risk of liver-related complications in NAFLD, and that transient elastography has similar prognostic accuracy as liver biopsy,” the authors said.