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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
A stepwise algorithm using an at-a-glance first-line test for the non-invasive diagnosis of advanced liver fibrosis
Jérôme Boursier1, Victor de Ledinghen2, Vincent Leroy3
1Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
Insights
A new easy liver fibrosis test (eLIFT) algorithm accurately detects advanced liver fibrosis in chronic liver disease patients. This reduces unnecessary referrals, improving patient management and specialist access.
Area of Science:
- Hepatology and Gastroenterology
- Diagnostic Medicine
- Biomarker Development
Background:
- Chronic liver diseases (CLD) are prevalent and often managed by non-hepatologists lacking access to advanced non-invasive fibrosis tests.
- Inaccurate disease severity assessment leads to suboptimal patient management and unnecessary specialist referrals.
Purpose of the Study:
- To implement a novel algorithm for advanced liver fibrosis detection in all CLD patients.
- To introduce a new, widely accessible first-line non-invasive test for initial fibrosis screening.
Main Methods:
- A diagnostic study randomized 3754 CLD patients with liver biopsy into derivation and validation sets.
- A prognostic study involved longitudinal follow-up of 1275 CLD patients with baseline fibrosis tests.
- Developed the easy liver fibrosis test (eLIFT) using age, gender, liver enzymes, and coagulation parameters.
Main Results:
- The eLIFT test demonstrated comparable sensitivity to FIB4 but with fewer false positives, especially in older patients.
- The eLIFT-FibroMeter with vibration controlled transient elastography (eLIFT-FMVCTE) algorithm achieved 76.1% sensitivity for advanced fibrosis and 92.1% for cirrhosis.
- Patients identified as having no/mild fibrosis by the algorithm showed excellent liver-related prognosis, negating the need for specialist referral.
Conclusions:
- The eLIFT-FMVCTE algorithm effectively identifies patients with advanced liver fibrosis, enabling timely specialist referral.
- This algorithm improves CLD management by extending accurate fibrosis detection to all patients and reducing unnecessary referrals.
Background & Aims:
Chronic liver diseases (CLD) are common, and are therefore mainly managed by non-hepatologists. These physicians lack access to the best non-invasive tests of liver fibrosis, and consequently cannot accurately determine the disease severity. Referral to a hepatologist is then needed. We aimed to implement an algorithm, comprising a new first-line test usable by all physicians, for the detection of advanced liver fibrosis in all CLD patients.
Methods:
Diagnostic study: 3754 CLD patients with liver biopsy were 2:1 randomized into derivation and validation sets. Prognostic study: longitudinal follow-up of 1275 CLD patients with baseline fibrosis tests.
Results:
Diagnostic study: the easy liver fibrosis test (eLIFT), an "at-a-glance" sum of points attributed to age, gender, gamma-glutamyl transferase, aspartate aminotransferase (AST), platelets and prothrombin time, was developed for the diagnosis of advanced fibrosis. In the validation set, eLIFT and fibrosis-4 (FIB4) had the same sensitivity (78.0% vs. 76.6%, p=0.470) but eLIFT gave fewer false positive results, especially in patients ≥60years old (53.8% vs. 82.0%, p<0.001), and was thus more suitable as screening test. FibroMeter with vibration controlled transient elastography (VCTE) was the most accurate among the eight fibrosis tests evaluated. The sensitivity of the eLIFT-FMVCTE algorithm (first-line eLIFT, second-line FibroMeterVCTE) was 76.1% for advanced fibrosis and 92.1% for cirrhosis. Prognostic study: patients diagnosed as having "no/mild fibrosis" by the algorithm had excellent liver-related prognosis with thus no need for referral to a hepatologist.
Conclusion:
The eLIFT-FMVCTE algorithm extends the detection of advanced liver fibrosis to all CLD patients and reduces unnecessary referrals of patients without significant CLD to hepatologists.
Lay Summary:
Blood fibrosis tests and transient elastography accurately diagnose advanced liver fibrosis in the large population of patients having chronic liver disease, but these non-invasive tests are only currently available in specialized centers. We have developed an algorithm including the easy liver fibrosis test (eLIFT), a new simple and widely available blood test. It is used as a first-line procedure that selects at-risk patients who need further evaluation with the FibroMeterVCTE, an accurate fibrosis test combining blood markers and transient elastography result. This new algorithm, called the eLIFT-FMVCTE, accurately identifies the patients with advanced chronic liver disease who need referral to a specialist, and those with no or mild liver lesions who can remain under the care of their usual physician.
Clinical Trial Registration:
No registration (analysis of pooled data from previously published diagnostic studies).
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