Jijo Varghese1, Krishnadas Devadas2
1Senior Resident, Medical Gastroenterology, Medical college Trivandrum, 2Professor and head of the department Medical Gastroenterology Medical college Trivandrum
Background/Aims: This study sought to propose a new diagnostic model for advanced fibrosis in an Asian population cohort affected with NAFLD.
Methods: cross sectional study conducted at Medical College Trivandrum. Period of study included 2 years .After excluding other possible potential causes of steatosis patients were subjected to Vibration-controlled transient elastography or Transient elastography (VCTE or TE) as a measure of hepatic fibrosis. Subjects were grouped into those with(TE>10Kpa) and without advanced fibrosis (TE<10Kpa) based on of TE. A new scoring system was then derived. This was then validated in a cohort of biopsy proven 84 NAFLD patients.
Results: 1617 NAFLD patients were included in the study .Independent predictors of advanced fibrosis in this cohort were Hip circumference, Triglycerides, Aspartate aminotransferase (AST) and Diabetes Mellitus (duration more than 10 years). Co-efficient of Beta for these variables were calculated. T-HAD score was calculated using the following formula - (Hip Circumference x 0.044 + AST x 0.028+ Diabetes Mellitus x3.7) - (0.03 x Triglycerides). AUROC of T-HAD score was 0.929.T-HAD score had sensitivity of 90% and specificity of 77% at a cut off of >2 for advanced fibrosis. We validated this score in another cohort of liver biopsy with advanced fibrosis. In the validation cohort T-HAD score had an AUROC of 0.926 in diagnosing advanced fibrosis (Sensitivity of 89% and specificity of 71% at a cut off of > 2)
Conclusion: T-HAD score based on Asian population is a new diagnostic model which is beneficial in estimating the risk of advanced fibrosis. It is a simple tool that could be in-cooperated into day to day practice in a resource limited setting.
Keywords: Novel diagnostic model, Advanced fibrosis, Non-Alcoholic Fatty Liver Disease