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Validation of noninvasive biomarkers (FibroTest, SteatoTest, and NashTest) for prediction of liver injury in patients with morbid obesity

Lassailly, Guillaumea,b; Caiazzo, Robertc,d; Hollebecque, Antoinea,b; Buob, Davide; Leteurtre, Emmanuellee; Arnalsteen, Laurentc,d; Louvet, Alexandrea,b; Pigeyre, Marief; Raverdy, Violetad; Verkindt, Hélèned; Six, Marie Franced; Eberle, Caroled; Patrice, Alexandred; Dharancy, Sébastiena,b; Romon, Moniquef; Pattou, Françoisc,d; Mathurin, Philippea,b

European Journal of Gastroenterology & Hepatology: June 2011 - Volume 23 - Issue 6 - p 499–506
doi: 10.1097/MEG.0b013e3283464111
Original Articles: Diagnosis in Liver Disease

Background Liver biopsy is considered as the gold standard for assessing nonalcoholic fatty liver disease (NAFLD) histologic lesions in patients with morbid obesity. The aim of this study was to determine the diagnostic utility of noninvasive markers of fibrosis (FibroTest), steatosis (SteatoTest), and steatohepatitis (NashTest, ActiTest) in these patients.

Materials and methods Two hundred and eighty-eight patients presenting with interpretable baseline operative biopsy and biomarkers, in an ongoing prospective cohort of patients treated with bariatric surgery, were included. Histology (NAFLD activity score, or NAFLD scoring system) and biochemical measurements were centralized and blinded to other characteristics. The area under the receiver operating characteristic curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (Obuchowski method) was used to prevent multiple testings and a spectrum effect.

Results The prevalence of advanced fibrosis (bridging) was 6.9%, advanced steatosis (>33%) was 48%, and steatohepatitis was 6.9% (NAFLD scoring system>4). Weighted AUROCs of the tests were as follows (mean, 95% confidence interval, significance): FibroTest for advanced fibrosis: 0.85, 0.83–0.87, P<0.0001; SteatoTest for advanced steatosis: 0.81, 0.79–0.83, P<0.0001; and ActiTest for steatohepatitis: 0.77, 0.73–0.81, P<0.0001.

Conclusion In patients with morbid obesity, the diagnostic performances of the FibroTest, SteatoTest, and ActiTest were statistically significant, thereby possibly reducing the need for biopsy in this population.

aService des Maladies de l'Appareil Digestif, Université Lille2

bUnité Inserm U 995

cUnité Inserm U 859

dServices de Chirurgie Endocrinienne

ed'Anatomie Pathologique

fNutrition, CHRU de Lille, Université Lille2, France

Correspondence to Pr Philippe Mathurin, Service des Maladies de l'Appareil Digestif, Université Lille2, Hôpital Claude Huriez 1er étage Est, Avenue Michel Polonovski, Lille 59037, France Tel: +33 3 20 44 55 97; fax: +33 3 20 44 55 64; e-mail:

Guillaume Lassailly, Robert Caiazzo, and Antoine Hollebecque contributed equally to this study

Received November 15, 2010

Accepted February 28, 2011

© 2011 Lippincott Williams & Wilkins, Inc.