Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
J Gastroenterol Hepatol. 2021 May;36(5):1309-1316. doi: 10.1111/jgh.15358. Epub 2020 Dec 16.
The FibroScan-aspartate aminotransferase (FAST) score was developed for identifying patients with non-alcoholic steatohepatitis, who also have an elevated non-alcoholic fatty liver disease (NAFLD) activity score (NAS) ≥ 4 and significant fibrosis (F ≥ 2). We aimed to validate it in our NAFLD cohort and assess if it correlates with the histological changes after bariatric surgery.
Patients with NAFLD, including those undergoing bariatric surgery, were included. The FAST score was calculated using liver stiffness measure, controlled attenuation parameter, and aspartate aminotransferase. Calibration and discrimination of the model were assessed by calibration plots and area under the receiver operating characteristic curve, respectively. Sensitivity and specificity were assessed at the rule-out and rule-in cutoffs (≤0.35 and ≥0.67), respectively. Changes in the NAS and FAST scores were compared in the bariatric cohort 1 year after surgery.
The cohort composed of 309 patients, of which 48 patients underwent repeat liver biopsy at 1 year. The model showed good discrimination with area under the receiver operating characteristic curve of 0.79 (0.74-0.84); however, it was not satisfactorily calibrated (Hosmer-Lemeshow test, P = 0.008). The sensitivity and specificity at the rule-out and rule-in cutoffs were 0.90 and 0.84, respectively. A significant correlation was seen between the 1-year reduction in the NAS and FAST scores (r = 0.38, P = 0.009). A significant reduction in the median FAST score was seen in patients who had ≥2-point reduction in NAS after bariatric surgery.
FibroScan-aspartate aminotransferase score demonstrated good discrimination for fibrotic non-alcoholic steatohepatitis in our cohort. However, a miscalibration resulted in overprediction. The score correlated well with the histological response to interventions for NAFLD.
FibroScan-天门冬氨酸氨基转移酶（FAST）评分用于识别非酒精性脂肪性肝炎（NASH）患者，这些患者的非酒精性脂肪性肝病（NAFLD）活动评分（NAS）≥4 且存在显著纤维化（F≥2）。我们旨在验证其在我们的 NAFLD 队列中的适用性，并评估其与减重手术后的组织学变化是否相关。
纳入了 NAFLD 患者，包括接受减重手术的患者。使用肝脏硬度测量值、受控衰减参数和天门冬氨酸氨基转移酶计算 FAST 评分。通过校准图和接收者操作特征曲线下面积分别评估模型的校准和区分能力。分别在排除和纳入截止值（≤0.35 和≥0.67）处评估敏感性和特异性。比较减重手术队列中 1 年后的 NAS 和 FAST 评分变化。
该队列包括 309 例患者，其中 48 例患者在 1 年后接受了重复肝活检。该模型具有良好的区分能力，接收者操作特征曲线下面积为 0.79（0.74-0.84）；然而，它的校准效果不理想（Hosmer-Lemeshow 检验，P=0.008）。排除和纳入截止值处的敏感性和特异性分别为 0.90 和 0.84。1 年内 NAS 和 FAST 评分的降低呈显著相关性（r=0.38，P=0.009）。减重手术后 NAS 降低≥2 分的患者 FAST 评分中位数显著降低。
FibroScan-天门冬氨酸氨基转移酶评分在我们的队列中对纤维化性 NASH 具有良好的区分能力。然而，校准不当导致了过度预测。该评分与 NAFLD 干预措施的组织学反应密切相关。
