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. 2020 Nov 16;5(4):559-572.
doi: 10.1002/hep4.1637. eCollection 2021 Apr.

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Hiroshi Ishiba  1   2 , Yoshio Sumida  3 , Yuya Seko  2 , Saiyu Tanaka  4 , Masato Yoneda  5 , Hideyuki Hyogo  6 , Masafumi Ono  7 , Hideki Fujii  8 , Yuichiro Eguchi  9 , Yasuaki Suzuki  10 , Masashi Yoneda  3 , Hirokazu Takahashi  9 , Takashi Nakahara  11 , Kojiro Mori  4 , Kazuyuki Kanemasa  4 , Keiji Shimada  12 , Kento Imajo  5 , Kanji Yamaguchi  2 , Takumi Kawaguchi  13 , Atsushi Nakajima  5 , Kazuaki Chayama  11 , Toshihide Shima  14 , Kazuma Fujimoto  9 , Takeshi Okanoue  14 , Yoshito Itoh  2 ; Japan Study Group of NAFLD
Affiliations

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Hiroshi Ishiba et al. Hepatol Commun. .

Abstract

This study aimed to examine whether the diagnostic accuracy of four noninvasive tests (NITs) for detecting advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is maintained or is inferior to with or without the presence of type 2 diabetes. Overall, 874 patients with biopsy-proven NAFLD were enrolled. After propensity-score matching by age, sex, and the prevalence of dyslipidemia, 311 patients were enrolled in each group of with or without diabetes. To evaluate the effect of diabetes, we compared the diagnostic accuracy of the fibrosis-4 (FIB-4) index, the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and type IV collagen 7S (COL4-7S) in patients with NAFLD with and without diabetes. The areas under the receiver operating characteristic curve (AUROC) for identifying advanced fibrosis in patients without diabetes were 0.879 for the FIB-4 index, 0.851 for the NFS, 0.862 for the APRI, and 0.883 for COL4-7S. The AUROCs in patients with diabetes were 0.790 for the FIB-4 index, 0.784 for the NFS, 0.771 for the APRI, and 0.872 for COL4-7S. The AUROC of COL4-7S was significantly larger than that of the other NITs in patients with NAFLD with diabetes than in those without diabetes. The optimal high and low cutoff points of COL4-7S were 5.9 ng/mL and 4.8 ng/mL, respectively. At the low cutoff point, the accuracy of COL4-7S was better than that of the other NITs, especially in patients with diabetes. Conclusion: COL4-7S measurement might be the best NIT for identifying advanced fibrosis in NAFLD, especially in NAFLD with diabetes.

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Figures

FIG. 1
FIG. 1
Box plot of NITs for advanced fibrosis of NAFLD with or without T2DM. *P < 0.01 versus F = 0‐2.
FIG. 2
FIG. 2
(A) ROC curve analysis of the FIB‐4 index, NFS, APRI, and COL4‐7S. The solid line indicates the absence of T2DM, and the broken line indicates the presence of T2DM. (B) DeLong test of each NIT of NAFLD with or without T2DM.
FIG. 3
FIG. 3
Low and high cutoff points of each NIT applied in this study.
FIG. 4
FIG. 4
Scatter plot of the correlation between age and platelet count or COL4‐7S, with or without T2DM.
See this image and copyright information in PMC

Comment in

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