COMMENT:
Despite this, LSM-VCTE and other non-invasive tests’ prognostic performances remain untested against that of liver biopsy. Importantly, the latter’s histological assessment of fibrosis stage is a widely accepted surrogate endpoint in NAFLD trials.
This meta-analysis aimed to directly compare the prognostic performance of non-invasive tests, including fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and LSM-VCTE, with liver histology in patients with NAFLD.
Key learnings:
Prognostic performance was assessed via standardised and weighted time-dependent receiver operating characteristic (tROC) curve analyses. Crucially, no significant difference between liver histology and non-invasive tools’ prognostic performance was noted. The area under the tROC curve at 5 years was 0.72, 0.76, 0.74 and 0.70 for histology, LSM-VCTE, FIB-4, and NFS, respectively. Non-invasive tests’ ability to effectively predict clinical outcomes remained even after controlling for confounders. Such non-invasive tools may thus be regarded as potential substitutes for liver biopsy during NAFLD clinical trials’ recruitment and surrogate endpoint clarification phases. This may expedite NAFLD drug development and discovery.
