Akademik Veri Yönetim Sistemi
JHEP REPORTS, cilt.5, sa.1, ss.100596-100601, 2023 (SCI-Expanded)
Non-invasive tests (NITs) are practical methods of advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk-stratification. We aim to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings.
A survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas.
There were 35 respondents from 24 countries and 89% practised in tertiary level settings. A total of 14 different NITs were used and each respondent reported using at least one (median=3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan®), followed by the NAFLD Fibrosis Score (49%). For FIB-4, 71% of respondents used a low cut-off of <1.3 (range <1.0 to <1.45) and 21% reported using age-specific cut-offs. For Fibroscan®, 21% of respondents used a single liver stiffness cut-off: 8 kPa in 50%, while the rest used 7.2 kPa, 7.8 kPa and 8.7 kPa. Among the 63% respondents who used lower and upper liver stiffness cut-offs, there were variations in both values (<5 to <10 kPa and >7.5 to >20 kPa, respectively).
The cut-offs used for the same NITs for NAFLD risk-stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines of standardised use of NITs in NAFLD management.