Micic Dejan, Huard Genevieve, Lee Sang Mee, Fiel M Isabel, Moon Jang, Schiano Thomas D, Iyer Kishore
Department of Internal Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA.
Department of Medicine, Division of Liver Diseases, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
JPEN J Parenter Enteral Nutr. 2022 Mar;46(3):678-684. doi: 10.1002/jpen.2135. Epub 2021 Jun 15.
Intestinal failure-associated liver disease (IFALD) refers to the spectrum of liver injury secondary to IF and parenteral nutrition use. Our aim was to evaluate the use of noninvasive indices of liver fibrosis to detect advanced fibrosis among individuals at risk for IFALD.
We performed a secondary analysis of a retrospective study, including all liver biopsies performed on individuals undergoing intestinal transplantation (ITx) between January 2000 and May 2014. To determine the clinical utility of detecting advanced fibrosis, receiver operating characteristic curves were developed. Comparison between the area under the curves was performed by DeLong test.
Fifty-three patients had a liver biopsy performed at the time of ITx; 13 of 53 (24.5%) patients had advanced fibrosis. The fibrosis-4 (FIB-4) index positively correlated to the stage of fibrosis on liver biopsy (r = 0.426, P = .002). When compared against the FIB-4 index, the aspartate aminotransferase to platelet ratio index had a significantly decreased ability to correctly identify the presence of advanced fibrosis (P = .019). When determining the cutoff value with 90% specificity for the detection of advanced fibrosis, a FIB-4 index of ≥4.4 had a sensitivity of 0.462 and a positive predictive value of 0.6.
In this retrospective cohort study, we found a positive correlation between the FIB-4 index and the liver fibrosis stage as characterized by the Brunt classification. This evaluation of the FIB-4 index against liver biopsies supports the use of the FIB-4 index in the detection of liver fibrosis in IF.
肠衰竭相关肝病（IFALD）指继发于肠衰竭（IF）和肠外营养使用的一系列肝损伤。我们的目的是评估使用肝纤维化的非侵入性指标来检测有IFALD风险个体中的晚期纤维化情况。
我们对一项回顾性研究进行了二次分析，纳入了2000年1月至2014年5月期间接受肠移植（ITx）的个体所进行的所有肝活检。为确定检测晚期纤维化的临床效用，绘制了受试者工作特征曲线。曲线下面积之间的比较采用德龙检验。
53例患者在ITx时进行了肝活检；53例患者中有13例（24.5%）存在晚期纤维化。纤维化-4（FIB-4）指数与肝活检的纤维化阶段呈正相关（r = 0.426，P = 0.002）。与FIB-4指数相比，天冬氨酸氨基转移酶与血小板比值指数正确识别晚期纤维化存在的能力显著降低（P = 0.019）。当确定检测晚期纤维化的特异性为90%的临界值时，FIB-4指数≥4.4的敏感度为0.462，阳性预测值为0.6。
在这项回顾性队列研究中，我们发现FIB-4指数与以布伦特分类法为特征的肝纤维化阶段呈正相关。对FIB-4指数与肝活检的这种评估支持在IF中使用FIB-4指数检测肝纤维化。
