Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study
Much of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy‐based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2021-06-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1689 |
| _version_ | 1797935496836415488 |
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| author | A. Sidney Barritt Stephanie Watkins Norman Gitlin Samuel Klein Anna S. Lok Rohit Loomba Cheryl Schoen K. Rajender Reddy Huy Ngoc Trinh Andrea R. Mospan Miriam B. Vos L. Michael Weiss Kenneth Cusi Brent A. Neuschwander‐Tetri Arun J. Sanyal |
| author_facet | A. Sidney Barritt Stephanie Watkins Norman Gitlin Samuel Klein Anna S. Lok Rohit Loomba Cheryl Schoen K. Rajender Reddy Huy Ngoc Trinh Andrea R. Mospan Miriam B. Vos L. Michael Weiss Kenneth Cusi Brent A. Neuschwander‐Tetri Arun J. Sanyal |
| author_sort | A. Sidney Barritt |
| collection | DOAJ |
| description | Much of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy‐based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real‐world practice. Adults from TARGET‐NASH were included in this study. Descriptive statistics are provided for the cohort and compare the characteristics of histologic NAFLD versus patients with clinically diagnosed NAFLD, followed by logistic regression and machine‐learning models to describe predictors of liver biopsy. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were White, and median body mass index was 32 kg/m2. Using histologic and/or clinical criteria, a diagnosis of nonalcoholic steatohepatitis was made in 37%, and cirrhosis in 33%. Comorbid conditions included cardiovascular disease (19%), mental health diagnoses (49%), and osteoarthritis (10%). Predictors of a biopsy diagnosis included White race, female sex, diabetes, and elevated alanine aminotransferase (ALT). ALT increased the odds of liver biopsy by 14% per 10‐point rise. Machine‐learning analyses showed non‐White patients with ALT <69 had only a 0.06 probability of undergoing liver biopsy. ALT was the dominant variable that determined liver biopsy. Conclusions: In this real‐world cohort of patients with NAFLD, two‐thirds of patients did not have a liver biopsy. These patients were more likely to be non‐White, older, with a normal ALT, showing potential gaps in or knowledge about this population. |
| first_indexed | 2024-04-10T18:15:11Z |
| format | Article |
| id | doaj.art-cd7644ce825744c5998578481955510e |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T18:15:11Z |
| publishDate | 2021-06-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-cd7644ce825744c5998578481955510e2023-02-02T09:08:48ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2021-06-015693894610.1002/hep4.1689Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH StudyA. Sidney Barritt0Stephanie Watkins1Norman Gitlin2Samuel Klein3Anna S. Lok4Rohit Loomba5Cheryl Schoen6K. Rajender Reddy7Huy Ngoc Trinh8Andrea R. Mospan9Miriam B. Vos10L. Michael Weiss11Kenneth Cusi12Brent A. Neuschwander‐Tetri13Arun J. Sanyal14Division of Gastroenterology and Hepatology UNC Liver CenterUniversity of North Carolina at Chapel Hill Chapel Hill NC USATarget RWE Durham NC USAAtlanta Gastroenterology Associates Atlanta GA USACenter for Human Nutrition and Atkins Center of Excellence in Obesity Medicine Washington University School of Medicine St. Louis MO USADivision of Gastroenterology and Hepatology University of Michigan Ann Arbor MI USADivision of Gastroenterology Department of Medicine University of California at San Diego CA USATarget RWE Durham NC USADivision of Gastroenterology and Hepatology University of Pennsylvania Philadelphia PA USASan Jose Gastroenterology San Jose CA USATarget RWE Durham NC USASchool of Medicine Emory University Children's Healthcare of Atlanta Atlanta GA USAGastro Florida Clearwater FL USADivision of Endocrinology, Diabetes and Metabolism University of Florida Gainesville FL USADivision of Gastroenterology and Hepatology Saint Louis University St. Louis MO USADivision of Gastroenterology, Hepatology and Nutrition Department of Internal Medicine Virginia Commonwealth UniversityVCU Medical Center–MCV CampusWest Hospital Richmond VA USAMuch of the current data on nonalcoholic fatty liver disease (NAFLD) are derived from biopsy‐based studies that may introduce ascertainment and selection bias. Selection of patients for liver biopsy has implications for clinical practice and the reported epidemiology of NAFLD. The aim of this study was to determine patient factors predictive of histologic versus empiric clinical diagnosis of NAFLD in real‐world practice. Adults from TARGET‐NASH were included in this study. Descriptive statistics are provided for the cohort and compare the characteristics of histologic NAFLD versus patients with clinically diagnosed NAFLD, followed by logistic regression and machine‐learning models to describe predictors of liver biopsy. The records of 3,474 subjects were analyzed; median age was 59 years, 59% were female, 75% were White, and median body mass index was 32 kg/m2. Using histologic and/or clinical criteria, a diagnosis of nonalcoholic steatohepatitis was made in 37%, and cirrhosis in 33%. Comorbid conditions included cardiovascular disease (19%), mental health diagnoses (49%), and osteoarthritis (10%). Predictors of a biopsy diagnosis included White race, female sex, diabetes, and elevated alanine aminotransferase (ALT). ALT increased the odds of liver biopsy by 14% per 10‐point rise. Machine‐learning analyses showed non‐White patients with ALT <69 had only a 0.06 probability of undergoing liver biopsy. ALT was the dominant variable that determined liver biopsy. Conclusions: In this real‐world cohort of patients with NAFLD, two‐thirds of patients did not have a liver biopsy. These patients were more likely to be non‐White, older, with a normal ALT, showing potential gaps in or knowledge about this population.https://doi.org/10.1002/hep4.1689 |
| spellingShingle | A. Sidney Barritt Stephanie Watkins Norman Gitlin Samuel Klein Anna S. Lok Rohit Loomba Cheryl Schoen K. Rajender Reddy Huy Ngoc Trinh Andrea R. Mospan Miriam B. Vos L. Michael Weiss Kenneth Cusi Brent A. Neuschwander‐Tetri Arun J. Sanyal Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study Hepatology Communications |
| title | Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study |
| title_full | Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study |
| title_fullStr | Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study |
| title_full_unstemmed | Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study |
| title_short | Patient Determinants for Histologic Diagnosis of NAFLD in the Real World: A TARGET‐NASH Study |
| title_sort | patient determinants for histologic diagnosis of nafld in the real world a target nash study |
| url | https://doi.org/10.1002/hep4.1689 |
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