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  • Diagnostic accuracy of FibroScan-AST (FAST) score for the non-invasive identification of patients with fibrotic non-alcoholic steatohepatitis: a systematic review and meta-analysis

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Hepatology
Original research
Diagnostic accuracy of FibroScan-AST (FAST) score for the non-invasive identification of patients with fibrotic non-alcoholic steatohepatitis: a systematic review and meta-analysis
  1. Federico Ravaioli1,2,3,
  2. Elton Dajti2,3,
  3. Alessandro Mantovani4,
  4. Philip Noel Newsome5,6,
  5. Giovanni Targher4,
  6. Antonio Colecchia1
  1. 1 Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena & Reggio Emilia, Modena, Italy
  2. 2 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
  3. 3 IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  4. 4 Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
  5. 5 National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6 Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Antonio Colecchia, Department of Medical Specialities, University of Modena and Reggio Emilia, Modena, 41121, Italy; antonio.colecchia{at}unimore.it

Abstract

Objective A simple combined score with liver stiffness, controlled attenuation parameter and serum aspartate aminotransferase (AST), the FibroScan-AST (FAST) score, has been proposed to non-invasively identify patients with fibrotic non-alcoholic steatohepatitis (NASH). We performed a systematic review and meta-analysis of published studies to evaluate the overall diagnostic accuracy of the FAST score in identifying patients with fibrotic NASH.

Design We systematically searched MEDLINE, Ovid Embase, Scopus and Cochrane Library electronic databases for full-text published articles in any language between 3 February 2020 and 30 April 2022. We included original articles that reported data for the calculation of sensitivity and specificity of the FAST score for identifying adult patients with fibrotic NASH adults, according to previously described rule-out (≤0.35) and rule-in (≥0.67) cut-offs.

Results We included 12 observational studies for a total of 5835 participants with biopsy-confirmed non-alcoholic fatty liver disease. The pooled prevalence of fibrotic NASH was 28% (95% CI 21% to 34%). The FAST score’s pooled sensitivity was 89% (95% CI 82% to 93%), and the pooled specificity was 89% (95% CI 83% to 94%) according to the aforementioned rule-in/rule-out cut-offs. The negative predictive value and positive predictive value of the FAST score were 92% (95% CI 91% to 95%) and 65% (95% CI 53% to 68%), respectively. Subgroup analyses and influential bias analyses did not alter these findings.

Conclusion The results of our meta-analysis show that the FAST score has a good performance for non-invasive diagnosis of fibrotic NASH. Therefore, this score can be used to efficiently identify patients who should be referred for a conclusive liver biopsy and/or consideration for treatment with emerging pharmacotherapies.

PROSPERO registration number CRD42022350945.

  • NONALCOHOLIC STEATOHEPATITIS
  • LIVER IMAGING
  • FATTY LIVER
  • ULTRASONOGRAPHY
  • HEPATIC FIBROSIS

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. The full search strategy and key results used to generate data that inform the conclusions of this systematic review can be found in online supplemental material.

https://doi.org/10.1136/gutjnl-2022-328689

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information. The full search strategy and key results used to generate data that inform the conclusions of this systematic review can be found in online supplemental material.

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    Footnotes

    • FR and ED are joint first authors.

    • GT and AC are joint senior authors.

    • Twitter @FedRavaioli, @EltonDajti, @phil_newsome7, @antoniocolecch3

    • FR and ED contributed equally.

    • Contributors FR, ED, AM, GT and AC formulated the research questions and developed the study protocol. FR, ED and AM collected and extracted the data, with GT and AC providing supervision and guarantors of the study. FR, ED, and AM analysed the data. FR, ED, AM, PNN, GT and AC wrote the manuscript. All authors had full access to all the data in the study, reviewed the manuscript, and had final responsibility for the decision to submit for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.