Key result
Higher CAP cut-offs yield ~94% specificity for diagnosing moderate-to-severe liver steatosis in morbidly obese patients.
Why the study?
To evaluate the diagnostic value of described CAP thresholds and biomarker scores, and to evaluate new cut-offs to detect moderate-to-severe steatosis in patients with morbid obesity.
Do higher cut-off values of non-invasive methods (CAP, Steato-ELSA, FLI, HSI) improve the detection of moderate-to-severe steatosis in morbidly obese patients?
Cross-Sectional (n=32)
Blinded assessors
No
Do higher cut-off values of non-invasive methods (CAP, Steato-ELSA, FLI, HSI) improve the detection of moderate-to-severe steatosis in morbidly obese patients?
Effect estimate: AUROC 0.897 (95% CI 0.769-1.000)
Higher cut-off values for non-invasive tests like CAP and biomarker scores may be necessary to accurately diagnose moderate-to-severe liver steatosis in patients with morbid obesity.
Higher cut-offs may enhance specificity of non-invasive steatosis tests in morbid obesity; leaves open need for prospective validation before practice change.
To evaluate the diagnostic value of described thresholds of controlled attenuation parameter (CAP) and biomarker scores for liver steatosis and to evaluate new cut-offs to detect moderate-to-severe steatosis (S2–3) in patients with morbid obesity. In this prospective study, 32 patients with morbid obesity with indications for bariatric surgery (15 women and 17 men, mean age = 36 years, median BMI = 40.2 kg/m2) underwent CAP, magnetic resonance spectroscopy (MRS), three biomarker scores (Steato-ELSA, Fatty Liver Index (FLI), and Hepatic Steatosis Index (HSI)), and liver biopsy. Subjects were divided into an exploratory cohort (reliable CAP and liver biopsy) and a confirmatory cohort (reliable CAP and MRS) to evaluate new thresholds for CAP and biomarker scores to detect S2–3. Receiver operator characteristic (ROC) curves analyses were performed and the optimal cut-off points were identified using the maximal Youden index. A total of 22 patients had CAP measure and liver biopsy (exploratory cohort) and 24 patients had CAP measure with MRS (confirmatory cohort). New cut-offs were identified for detection of S2–3 by the non-invasive tests using liver biopsy as the reference standard (exploratory cohort). Considering the new proposed cut-offs for detection of S2–3 for CAP (≥ 314 dB/m), Steato-ELSA (≥ 0.832), FLI (≥ 96), and HSI (≥ 53), for the exploratory and confirmatory cohorts sensitivities were: 71–75%, 86–81%, 85–81%, and 71–69% and specificities were: 94–89%, 75–63%, 63–63%, and 75–88%, respectively. Higher cut-offs for CAP and biomarker scores may be better to diagnose moderate-to-severe steatosis in patients with morbid obesity.
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Parente et al. (2020) conducted a cross-sectional in Morbid obesity with suspected non-alcoholic fatty liver disease (n=32). Higher cut-off values for Controlled Attenuation Parameter (CAP ≥ 314 dB/m) and biomarker scores vs. Standard cut-off values for the general population (CAP ≥ 268 dB/m) was evaluated on Area under the receiver operator characteristic curve (AUROC) of CAP for detection of moderate-to-severe steatosis in the exploratory cohort (AUROC 0.897, 95% CI 0.769-1.000). Higher cut-offs for non-invasive tests, such as a Controlled Attenuation Parameter ≥ 314 dB/m, provided better specificity (94%) for diagnosing moderate-to-severe liver steatosis in morbidly obese patients compared to standard thresholds.
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