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dc.contributor.authorPetroff, Den
dc.contributor.authorBlank, Ven
dc.contributor.authorNewsome, PNen
dc.contributor.authorShalimaren
dc.contributor.authorVoican, CSen
dc.contributor.authorThiele, Men
dc.contributor.authorde Lédinghen, Ven
dc.contributor.authorBaumeler, Sen
dc.contributor.authorChan, WKen
dc.contributor.authorPerlemuter, Gen
dc.contributor.authorCardoso, A-Cen
dc.contributor.authorAggarwal, Sen
dc.contributor.authorSasso, Men
dc.contributor.authorEddowes, PJen
dc.contributor.authorAllison, Men
dc.contributor.authorTsochatzis, Een
dc.contributor.authorAnstee, QMen
dc.contributor.authorSheridan, Den
dc.contributor.authorCobbold, JFen
dc.contributor.authorNaveau, Sen
dc.contributor.authorLupsor-Platon, Men
dc.contributor.authorMueller, Sen
dc.contributor.authorKrag, Aen
dc.contributor.authorIrles-Depe, Men
dc.contributor.authorSemela, Den
dc.contributor.authorWong, GL-Hen
dc.contributor.authorWong, VW-Sen
dc.contributor.authorVillela-Nogueira, CAen
dc.contributor.authorGarg, Hen
dc.contributor.authorChazouillères, Oen
dc.contributor.authorWiegand, Jen
dc.contributor.authorKarlas, Ten
dc.date.accessioned2021-11-09T16:16:01Z
dc.date.issued2021-03en
dc.identifier.urihttp://hdl.handle.net/10026.1/18283
dc.description.abstract

BACKGROUND: Diagnostic tools for liver disease can now include estimation of the grade of hepatic steatosis (S0 to S3). Controlled attenuation parameter (CAP) is a non-invasive method for assessing hepatic steatosis that has become available for patients who are obese (FibroScan XL probe), but a consensus has not yet been reached regarding cutoffs and its diagnostic performance. We aimed to assess diagnostic properties and identify relevant covariates with use of an individual patient data meta-analysis. METHODS: We did an individual patient data meta-analysis, in which we searched PubMed and Web of Science for studies published from database inception until April 30, 2019. Studies reporting original biopsy-controlled data of CAP for non-invasive grading of steatosis were eligible. Probe recommendation was based on automated selection, manual assessment of skin-to-liver-capsule distance, and a body-mass index (BMI) criterion. Receiver operating characteristic methods and mixed models were used to assess diagnostic properties and covariates. Patients with non-alcoholic fatty liver disease (NAFLD) were analysed separately because they are the predominant patient group when using the XL probe. This study is registered with PROSPERO, CRD42018099284. FINDINGS: 16 studies reported histology-controlled CAP including the XL probe, and individual data from 13 papers and 2346 patients were included. Patients with a mean age of 46·5 years (SD 14·5) were recruited from 20 centres in nine countries. 2283 patients had data for BMI; 673 (29%) were normal weight (BMI <25 kg/m2), 530 (23%) were overweight (BMI ≥25 to <30 kg/m2), and 1080 (47%) were obese (BMI ≥30 kg/m2). 1277 (54%) patients had NAFLD, 474 (20%) had viral hepatitis, 285 (12%) had alcohol-associated liver disease, and 310 (13%) had other liver disease aetiologies. The XL probe was recommended in 1050 patients, 930 (89%) of whom had NAFLD; among the patients with NAFLD, the areas under the curve were 0·819 (95% CI 0·769-0·869) for S0 versus S1 to S3 and 0·754 (0·720-0·787) for S0 to S1 versus S2 to S3. CAP values were independently affected by aetiology, diabetes, BMI, aspartate aminotransferase, and sex. Optimal cutoffs differed substantially across aetiologies. Risk of bias according to QUADAS-2 was low. INTERPRETATION: CAP cutoffs varied according to cause, and can effectively recognise significant steatosis in patients with viral hepatitis. CAP cannot grade steatosis in patients with NAFLD adequately, but its value in a NAFLD screening setting needs to be studied, ideally with methods beyond the traditional histological reference standard. FUNDING: The German Federal Ministry of Education and Research and Echosens.

en
dc.format.extent185 - 198en
dc.languageengen
dc.language.isoengen
dc.subjectAdulten
dc.subjectArea Under Curveen
dc.subjectBiopsyen
dc.subjectBody Mass Indexen
dc.subjectElasticity Imaging Techniquesen
dc.subjectFemaleen
dc.subjectHumansen
dc.subjectLiveren
dc.subjectMaleen
dc.subjectMiddle Ageden
dc.subjectNon-alcoholic Fatty Liver Diseaseen
dc.subjectROC Curveen
dc.subjectSeverity of Illness Indexen
dc.titleAssessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis.en
dc.typeJournal Article
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/33460567en
plymouth.issue3en
plymouth.volume6en
plymouth.publication-statusPublisheden
plymouth.journalLancet Gastroenterol Hepatolen
dc.identifier.doi10.1016/S2468-1253(20)30357-5en
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeNetherlandsen
dcterms.dateAccepted2020-10-27en
dc.rights.embargodate9999-12-31en
dc.identifier.eissn2468-1253en
dc.rights.embargoperiodNot knownen
rioxxterms.versionofrecord10.1016/S2468-1253(20)30357-5en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2021-03en
rioxxterms.typeJournal Article/Reviewen


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