1. Serum metabolites detect the presence of advanced fibrosis in derivation and validation cohorts of patients with non-alcoholic fatty liver disease.
- Author
-
Caussy, Cyrielle, Ajmera, Veeral H, Puri, Puneet, Hsu, Cynthia Li-Shin, Bassirian, Shirin, Mgdsyan, Mania, Singh, Seema, Faulkner, Claire, Valasek, Mark A, Rizo, Emily, Richards, Lisa, Brenner, David A, Sirlin, Claude B, Sanyal, Arun J, and Loomba, Rohit
- Subjects
Humans ,Liver Cirrhosis ,Alanine Transaminase ,Aspartate Aminotransferases ,Magnetic Resonance Imaging ,Biopsy ,Prognosis ,Severity of Illness Index ,Follow-Up Studies ,Prospective Studies ,Cross-Sectional Studies ,Middle Aged ,Female ,Male ,Elasticity Imaging Techniques ,Non-alcoholic Fatty Liver Disease ,Biomarkers ,hepatic fibrosis ,magnetic resonance imaging ,nonalcoholic steatohepatitis ,Chronic Liver Disease and Cirrhosis ,Liver Disease ,Digestive Diseases ,Clinical Research ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Gastroenterology & Hepatology - Abstract
ObjectiveNon-invasive and accurate diagnostic tests for the screening of disease severity in non-alcoholic fatty liver disease (NAFLD) remain a major unmet need. Therefore, we aimed to examine if a combination of serum metabolites can accurately predict the presence of advanced fibrosis.DesignThis is a cross-sectional analysis of a prospective derivation cohort including 156 well-characterised patients with biopsy-proven NAFLD and two validation cohorts, including (1) 142 patients assessed using MRI elastography (MRE) and(2) 59 patients with biopsy-proven NAFLD with untargeted serum metabolome profiling.ResultsIn the derivation cohort, 23 participants (15%) had advanced fibrosis and 32 of 652 analysed metabolites were significantly associated with advanced fibrosis after false-discovery rate adjustment. Among the top 10 metabolites, 8 lipids (5alpha-androstan-3beta monosulfate, pregnanediol-3-glucuronide, androsterone sulfate, epiandrosterone sulfate, palmitoleate, dehydroisoandrosterone sulfate, 5alpha-androstan-3beta disulfate, glycocholate), one amino acid (taurine) and one carbohydrate (fucose) were identified. The combined area under the receiver operating characteristic curve (AUROC) of the top 10 metabolite panel was higher than FIB--4 and NAFLD Fibrosis Score (NFS) for the detection of advanced fibrosis: 0.94 (95% CI 0.897 to 0.982) versus 0.78 (95% CI0.674 to 0.891), p=0.002 and versus 0.84 (95% CI 0.724 to 0.929), p=0.017, respectively. The AUROC of the top 10 metabolite panel remained excellent in the independent validation cohorts assessed by MRE or liver biopsy: c-statistic of 0.94 and 0.84, respectively.ConclusionA combination of 10 serum metabolites demonstrated excellent discriminatory ability for the detection of advanced fibrosis in an derivation and two independent validation cohorts with greater diagnostic accuracy than the FIB-4-index and NFS. This proof-of-concept study demonstrates that a non-invasive blood-based diagnostic test can provide excellent performance characteristics for the detection of advanced fibrosis.
- Published
- 2019