Optimal thresholds for ultrasound attenuation parameter in the evaluation of hepatic steatosis severity: evidence from a cohort of patients with biopsy-proven fatty liver disease
Zhu, Sheng-Haoa; Zheng, Kenneth I.b; Hu, Di-Shuanga; Gao, Fenga; Rios, Rafael S.b; Li, Gangb; Li, Yang-Yangc; Byrne, Christopher D.d; Targher, Giovannie; Chen, Yong-Pingb,,f,,g; Zheng, Ming-Huab,,f,,gAuthor Information
aDepartment of Gastroenterology
bNAFLD Research Center, Department of Hepatology
cDepartment of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
dSouthampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK
eSection of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
fInstitute of Hepatology, Wenzhou Medical University
gKey Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
Received 2 March 2020 Accepted 1 April 2020
Lay summary
Ultrasound attenuation parameter (UAP) generated by FibroTouch is an accurate tool to noninvasively detect and stage the presence of hepatic steatosis. Our proposed UAP cutoff values might be feasible in routine clinical practice.
Correspondence to Ming-Hua Zheng, MD, PhD, NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou 325000, China, Tel: +86 577 55579622; fax: +86 577 55578522; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: March 2021 - Volume 33 - Issue 3 - p 430-435
doi: 10.1097/MEG.0000000000001746
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Abstract
Objective
FibroTouch is a newly developed device to assess ultrasound attenuation parameter (UAP) and liver stiffness measurement to quantify hepatic steatosis and fibrosis, respectively. However, there is currently a lack of defined thresholds of UAP to diagnose different stages of hepatic steatosis. We aimed to assess the optimal thresholds of UAP for hepatic steatosis in individuals with biopsy-proven fatty liver disease (FLD).
Methods
We enrolled 497 adults with FLD undergoing FibroTouch and liver biopsy. Area under the receiver operating characteristic curve (AUROC) was performed to calculate the performance of UAP in staging hepatic steatosis. Hepatic steatosis >33% was defined as significant steatosis. We determined the optimal cutoff values of UAP and the sensitivity or specificity higher than 90%. Sensitivity, specificity, positive predictive value and negative predictive value were subsequently calculated.
Results
The median UAP for the enrolled patients was 308 dB/m. Multivariable logistic regression analysis showed that UAP was associated with significant steatosis [adjusted-odds ratio 1.05, 95% confidence interval (CI), 1.02–1.09; P = 0.001]. The AUROCs for S ≥ 1, S ≥ 2 and S = 3 were 0.88 (95% CI, 0.84–0.91), 0.77 (95% CI, 0.73–0.81), and 0.70 (95% CI, 0.63–0.77), respectively. The optimal UAP cutoffs were 295 dB/m for S ≥ 1, 314 dB/m for S ≥ 2, and 324 dB/m for S = 3. Almost identical results were observed in the subgroup of patients with biopsy-confirmed nonalcoholic fatty liver disease (n = 435).
Conclusion