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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Accuracy of Noninvasive Scoring Systems in Assessing Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Sangsoo Han1 , Miyoung Choi2 , Bora Lee3 , Hye-Won Lee4 , Seong Hee Kang5 , Yuri Cho6 , Sang Bong Ahn7 , Do Seon Song8 , Dae Won Jun9 , Jieun Lee10 , and Jeong-Ju Yoo11

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 2Clinical Evidence Research, National Evidence-based Healthcare Collaborating Agency (NECA), 3Department of Statistics, Graduate School of Chung-Ang University, 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 5Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 6Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, 7Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, 8Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, 9Department of Internal Medicine, Hanyang University College of Medicine, Seoul, 10Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, and 11Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Correspondence to:Dae Won Jun
ORCID https://orcid.org/0000-0002-2875-6139
E-mail noshin@hanyang.ac.kr
Jeong-Ju Yoo
ORCID https://orcid.org/0000-0002-7802-0381
E-mail puby17@naver.comr

Received: August 24, 2021; Revised: November 18, 2021; Accepted: November 23, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver

Published online February 23, 2022

Copyright © Gut and Liver.

Abstract

Background/Aims: Several noninvasive scoring systems have been developed to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). We examined the diagnostic accuracy of the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS) in patients with biopsy-proven NAFLD.
Methods: For this meta-analysis, various databases including PubMed (MEDLINE), EMBASE, OVID Medline and the Cochrane Library were systematically searched. After the acquired abstracts were reviewed by two investigators, manuscripts were chosen for a full-text examination.
Results: Thirty-six studies evaluating biopsy-proven NAFLD were selected for meta-analysis. A total of 14,992 patients were analyzed. The lower cutoff sensitivity of the FIB-4 score predicting histological fibrosis stage 3 or more (≥F3) was 69%, with specificity of 64%, positive likelihood ratio (LR+) of 1.96, and negative likelihood ratio (LR–) of 0.47. The low baseline sensitivity of the NFS score predicting ≥F3 was 70%, with a specificity of 61%, LR+ of 1.83, and LR– of 0.48. The area under the receiver operating characteristic curve (AUC) values of the FIB-4 score predicting ≥F3 and ≥F2 were 76% and 68%, respectively. The AUC values of the NFS score predicting ≥F3 and ≥F2 were 74% and 60%, respectively.
Conclusions: The FIB-4 or NFS test can be used to predict the degree of liver fibrosis in NAFLD, and the diagnostic accuracy resulted as relatively high in fibrosis stages of F3 or higher.

Keywords: Liver fibrosis, Meta-analysis, Nonalcoholic fatty liver disease, Predictive value of tests


Article

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Gut and Liver

Published online February 23, 2022

Copyright © Gut and Liver.

Accuracy of Noninvasive Scoring Systems in Assessing Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Sangsoo Han1 , Miyoung Choi2 , Bora Lee3 , Hye-Won Lee4 , Seong Hee Kang5 , Yuri Cho6 , Sang Bong Ahn7 , Do Seon Song8 , Dae Won Jun9 , Jieun Lee10 , and Jeong-Ju Yoo11

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 2Clinical Evidence Research, National Evidence-based Healthcare Collaborating Agency (NECA), 3Department of Statistics, Graduate School of Chung-Ang University, 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 5Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 6Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, 7Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, 8Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, 9Department of Internal Medicine, Hanyang University College of Medicine, Seoul, 10Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, and 11Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Correspondence to:Dae Won Jun
ORCID https://orcid.org/0000-0002-2875-6139
E-mail noshin@hanyang.ac.kr
Jeong-Ju Yoo
ORCID https://orcid.org/0000-0002-7802-0381
E-mail puby17@naver.comr

Received: August 24, 2021; Revised: November 18, 2021; Accepted: November 23, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims: Several noninvasive scoring systems have been developed to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). We examined the diagnostic accuracy of the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS) in patients with biopsy-proven NAFLD.
Methods: For this meta-analysis, various databases including PubMed (MEDLINE), EMBASE, OVID Medline and the Cochrane Library were systematically searched. After the acquired abstracts were reviewed by two investigators, manuscripts were chosen for a full-text examination.
Results: Thirty-six studies evaluating biopsy-proven NAFLD were selected for meta-analysis. A total of 14,992 patients were analyzed. The lower cutoff sensitivity of the FIB-4 score predicting histological fibrosis stage 3 or more (≥F3) was 69%, with specificity of 64%, positive likelihood ratio (LR+) of 1.96, and negative likelihood ratio (LR–) of 0.47. The low baseline sensitivity of the NFS score predicting ≥F3 was 70%, with a specificity of 61%, LR+ of 1.83, and LR– of 0.48. The area under the receiver operating characteristic curve (AUC) values of the FIB-4 score predicting ≥F3 and ≥F2 were 76% and 68%, respectively. The AUC values of the NFS score predicting ≥F3 and ≥F2 were 74% and 60%, respectively.
Conclusions: The FIB-4 or NFS test can be used to predict the degree of liver fibrosis in NAFLD, and the diagnostic accuracy resulted as relatively high in fibrosis stages of F3 or higher.

Keywords: Liver fibrosis, Meta-analysis, Nonalcoholic fatty liver disease, Predictive value of tests

Gut and Liver

Vol.16 No.3
May, 2022

pISSN 1976-2283
eISSN 2005-1212

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