Diagnostic accuracy of blood biomarkers and non-invasive scores for the diagnosis of NAFLD and NASH: Systematic review and meta-analysis

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Abstract

Fatty liver disease is an important public health problem. Early diagnosis is critical to lower its rate of progression to irreversible/terminal stages. This study aimed to evaluate the accuracy of non-invasive prediction scores for fatty liver disease (NAFLD and NASH) diagnosis in adults.

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Most cited references 65

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QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.

Penny F Whiting, Anne W S Rutjes, Marie E Westwood … (2011)

In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.

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The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.

Naga Chalasani, Zobair Younossi, Joel E Lavine … (2018)

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A new definition for metabolic associated fatty liver disease: an international expert consensus statement

Mohammed Eslam, Philip N. Newsome, Quentin M Anstee … (2020)

The exclusion of other chronic liver diseases including "excess" alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, "positive criteria" to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward.

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Author and article information

Contributors

Daniela Contreras: (View ORCID Profile)

Alejandra González-Rocha: (View ORCID Profile)

Journal

Title: Annals of Hepatology

Abbreviated Title: Annals of Hepatology

Publisher: Elsevier BV

ISSN (Print): 16652681

Publication date Created: January 2023

Publication date (Print): January 2023

Volume: 28

Issue: 1

Page: 100873

Article

DOI: 10.1016/j.aohep.2022.100873

PubMed ID: 36371077

SO-VID: b17474b1-56b5-41f5-b2d9-5c86b82fd64f

License:

https://www.elsevier.com/tdm/userlicense/1.0/

http://creativecommons.org/licenses/by-nc-nd/4.0/

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Diagnostic accuracy of blood biomarkers and non-invasive scores for the diagnosis of NAFLD and NASH: Systematic review and meta-analysis

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Most cited references 65

QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.

The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.

A new definition for metabolic associated fatty liver disease: an international expert consensus statement

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