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- Title
Predictive Algorithm for Hepatic Steatosis Detection Using Elastography Data in the Veterans Affairs Electronic Health Records.
- Authors
Bangaru, Saroja; Sundaresh, Ram; Lee, Anna; Prause, Nicole; Hao, Frank; Dong, Tien S.; Tincopa, Monica; Cholankeril, George; Rich, Nicole E.; Kawamoto, Jenna; Bhattacharya, Debika; Han, Steven B.; Patel, Arpan A.; Shaheen, Magda; Benhammou, Jihane N.
- Abstract
Background and Aims: Nonalcoholic fatty liver disease (NAFLD) has reached pandemic proportions. Early detection can identify at-risk patients who can be linked to hepatology care. The vibration-controlled transient elastography (VCTE) controlled attenuation parameter (CAP) is biopsy validated to diagnose hepatic steatosis (HS). We aimed to develop a novel clinical predictive algorithm for HS using the CAP score at a Veterans' Affairs hospital. Methods: We identified 403 patients in the Greater Los Angeles VA Healthcare System with valid VCTEs during 1/2018–6/2020. Patients with alcohol-associated liver disease, genotype 3 hepatitis C, any malignancies, or liver transplantation were excluded. Linear regression was used to identify predictors of NAFLD. To identify a CAP threshold for HS detection, receiver operating characteristic analysis was applied using liver biopsy, MRI, and ultrasound as the gold standards. Results: The cohort was racially/ethnically diverse (26% Black/African American; 20% Hispanic). Significant positive predictors of elevated CAP score included diabetes, cholesterol, triglycerides, BMI, and self-identifying as Hispanic. Our predictions of CAP scores using this model strongly correlated (r = 0.61, p < 0.001) with actual CAP scores. The NAFLD model was validated in an independent Veteran cohort and yielded a sensitivity of 82% and specificity 83% (p < 0.001, 95% CI 0.46–0.81%). The estimated optimal CAP for our population cut-off was 273.5 dB/m, resulting in AUC = 75.5% (95% CI 70.7–80.3%). Conclusion: Our HS predictive algorithm can identify at-risk Veterans for NAFLD to further risk stratify them by non-invasive tests and link them to sub-specialty care. Given the biased referral pattern for VCTEs, future work will need to address its applicability in non-specialty clinics. Proposed clinical algorithm to identify patients at-risk for NAFLD prior to fibrosis staging in Veteran.
- Subjects
ELECTRONIC health records; NON-alcoholic fatty liver disease; FATTY liver; HEPATITIS C; VETERANS' hospitals; RECEIVER operating characteristic curves; ELASTOGRAPHY
- Publication
Digestive Diseases & Sciences, 2023, Vol 68, Issue 12, p4474
- ISSN
0163-2116
- Publication type
Article
- DOI
10.1007/s10620-023-08043-8