Mary Barbara, MD
San Antonio, Texas
Mary Barbara, MD1, Giuseppe Annunziata, MD1, Mazen Noureddin, MD2, Naim Alkhouri, MD3
1University of Texas Health Science Center, San Antonio, TX; 2Cedars-Sinai Medical Center, Los Angeles, CA; 3Texas Liver Institute, San Antonio, TX
Introduction: In patients with nonalcoholic fatty liver disease, Hispanic ethnicity and the presence of type 2 diabetes mellitus (T2DM) are associated with advanced fibrosis (AF). The NAFLD fibrosis score (NFS) is a noninvasive test that has been validated to predict AF but was originally developed in mainly a Caucasian population. The aim of our study was to assess the performance of NFS in Hispanic patients with T2DM and biopsy proven NAFLD
Methods: This was a single institutional study in south Texas. Using ICD 9/ ICD 10 codes, a retrospective chart review between 2010-2017 identified 55,670 patients with T2DM between ages 18-80. 479 out of 55,670 patients had a liver biopsy. The stage of liver fibrosis was scored from F0 to F4 with (F0-2) defined as early fibrosis and (F3-4) as advanced fibrosis (AF). NFS was calculated and patients were divided into three groups: low score (< -1.45), intermediate score ( -1.45-0.676) and high score consistent with advance fibrosis ( > 0.676). Analysis was performed using Stata IC 15. A p value < 0.05 was considered statistically significant. Area under the ROC curve (AUC) analysis was done to determine NFS accuracy
Results: After excluding patients with missing data to calculate NFS and those with liver transplant, total of 311 patients were included in the study. The mean age was 55.15 ± 9 years, 55.31% were females, mean BMI 33.16 ± 7.9 kg/m2, mean AST 45.56 ± 44.78 U/L, ALT 52.03 ± 38.75 U/L, albumin 3.44 ± 0.60 g/dl, platelets 203.97 ±84.61 KuL, and the mean NFS was 0.627 ± 1.78. 40% of the patients (125 out of 311) had AF proven by liver biopsy. AF was more predominant among females (43% vs 35%). AUC for NFS to predict AF was 0.73, SE 0.02, 95% CL [0.68-0.79], P< 0.001. At the low cutoff point; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 97%, 11 %, 42 % and 78%, respectively and 67%,72%, 61% and 76% at the high cutoff point ( >0.676). Interestingly, 47% of the cohort was in the intermediate score, 24% of the intermediate group had AF (F3-4) vs 76 % had early fibrosis (F0-2)
Discussion: NFS had a fair diagnostic accuracy for predicting the presence of AF in Hispanic patients with NAFLD and T2DM with AUC of 0.73. A large percentage of our cohort was in the intermediate zone indicating the need for sequential testing with other noninvasive tests to improve accuracy
Citation: Mary Barbara, MD; Giuseppe Annunziata, MD; Mazen Noureddin, MD; Naim Alkhouri, MD. P0649 - THE PERFORMANCE OF THE NAFLD FIBROSIS SCORE IN HISPANICS WITH TYPE 2 DIABETES AND BIOPSY-PROVEN NAFLD. Program No. P0649. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.