Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 14, Number 4, August 2021, pages 244-251

Non-Invasive Assessment of Liver Fibrosis and Steatosis in End-Stage Renal Disease Patients Undergoing Renal Transplant Evaluation

**Table 1.** Demographic and Clinical Values of the Study Population
Characteristic	Patient cohort (n = 171)
^aMean ± SD. ^bMedian (IQR). BMI: body mass index; AST: aspartate aminotransferase; ALT: alanine aminotransferase; SD: standard deviation.
Age^a	56 (12)
Male, n (%)	111 (65)
Black, n (%)	102 (60)
Non-Hispanic	99%
BMI^a (SD)	28.9 (5.4)
BMI ≥ 30, n (%)	61 (36)
Diabetes, n (%)	80 (47)
Hypertension, n (%)	164 (96)
Dyslipidemia, n (%)	95 (56)
AST (IU/L)	31 (29)^a, 24 (19 - 35)^b
ALT (IU/L)	29 (45)^a, 18 (13 - 29)^b
Platelets (× 10³/mL)	215 (86)^a, 201 (157 - 262)^b

Table 1. Demographic and Clinical Values of the Study Population

Characteristic

Patient cohort (n = 171)

^aMean ± SD. ^bMedian (IQR). BMI: body mass index; AST: aspartate aminotransferase; ALT: alanine aminotransferase; SD: standard deviation.

Age^a

56 (12)

Male, n (%)

111 (65)

Black, n (%)

102 (60)

Non-Hispanic

99%

BMI^a (SD)

28.9 (5.4)

BMI ≥ 30, n (%)

61 (36)

Diabetes, n (%)

80 (47)

Hypertension, n (%)

164 (96)

Dyslipidemia, n (%)

95 (56)

AST (IU/L)

31 (29)^a, 24 (19 - 35)^b

ALT (IU/L)

29 (45)^a, 18 (13 - 29)^b

Platelets (× 10³/mL)

215 (86)^a, 201 (157 - 262)^b

**Table 2.** Assessment of Each Non-Invasive Test to Identify Advanced Fibrosis and Steatosis
Non-invasive tests	Established cutoffs	Results
^aMean ± SD. ^bMedian (IQR). LS: liver stiffness; CAP: controlled attenuated parameter; M/XL: medium/large size probe; SD: standard deviation.
Transient elastography (TE)	LS (kPa)	8.3 (7.1)^a, 6.5 (4.7 - 8.9)^b
	LS IQR/median^a	13.2 (5.4)
	LS ≥ 9	21%
	CAP (dB/m)^a	232 (61)
	CAP IQR^a	40 (20)
	CAP ≥ 263 (dB/m)	25%
	Probe (M/XL)	62%/38%
AST to platelet ratio index (APRI)	APRI	0.35 (0.39)^a, 0.025 (0.016 - 0.37)^b
	APRI > 1.5	1.8%
Fibrosis-4 (FIB-4) score	FIB-4	1.97 (1.33)^a , 0.72 (1.07 - 2.37)^b
	FIB-4 > 2.67	15%
Non-alcoholic fatty liver disease fibrosis score (NFS)	NFS	-0.408 (1.61)^a , -0.385 (-1.56 - 0.51)^b
	NFS > 0.65	23%

Table 2. Assessment of Each Non-Invasive Test to Identify Advanced Fibrosis and Steatosis

Non-invasive tests

Established cutoffs

Results

^aMean ± SD. ^bMedian (IQR). LS: liver stiffness; CAP: controlled attenuated parameter; M/XL: medium/large size probe; SD: standard deviation.

Transient elastography (TE)

LS (kPa)

8.3 (7.1)^a, 6.5 (4.7 - 8.9)^b

LS IQR/median^a

13.2 (5.4)

LS ≥ 9

21%

CAP (dB/m)^a

232 (61)

CAP IQR^a

40 (20)

CAP ≥ 263 (dB/m)

25%

Probe (M/XL)

62%/38%

AST to platelet ratio index (APRI)

APRI

0.35 (0.39)^a, 0.025 (0.016 - 0.37)^b

APRI > 1.5

1.8%

Fibrosis-4 (FIB-4) score

FIB-4

1.97 (1.33)^a , 0.72 (1.07 - 2.37)^b

FIB-4 > 2.67

15%

Non-alcoholic fatty liver disease fibrosis score (NFS)

NFS

-0.408 (1.61)^a , -0.385 (-1.56 - 0.51)^b

NFS > 0.65

23%

**Table 3.** Comparison of Multiple Variables and Serum-Based Non-Invasive Models With Transient Elastography for Detection of Advanced Fibrosis (LS ≥ 9 kPa)
Variables and models	LS < 9 kPa	LS ≥ 9 kPa	P values
^aMean ± SD. LS: liver stiffness (by transient elastography); BMI: body mass index; DM: diabetes mellitus; CAP: controlled attenuated parameter; DL: dyslipidemia; XL: large probe; AST: aspartate aminotransferase; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score; SD: standard deviation.
Patients (n)	135	36
Male (%)	61	75
Black (%)	59	64
Age^a	54 (12)	62 (10)	0.005
%BMI ≥ 30	37	31
%DM	44	56
%CAP > 263 dB/m	25	25
%DL	54	62
XL probe (%)	38	35
AST (IU/L)^a	31.6 (32.7)	30.8 (14.9)
ALT (IU/L)^a	29.48 (50.4)	26.2 (19.9)
Platelets (× 10³/mL)^a	218 (89)	203 (76)
APRI^a	0.35 (0.42)	0.34 (0.23)
%APRI > 1.5	22	0
FIB-4^a	1.89 (1.27)	2.28 (1.5)
%FIB-4 > 2.67	20	23
NFS^a	-0.560 (1.61)	0.138 (1.52)	0.021
%NFS > 0.675	16	36	0.007

Table 3. Comparison of Multiple Variables and Serum-Based Non-Invasive Models With Transient Elastography for Detection of Advanced Fibrosis (LS ≥ 9 kPa)

Variables and models

LS < 9 kPa

LS ≥ 9 kPa

P values

^aMean ± SD. LS: liver stiffness (by transient elastography); BMI: body mass index; DM: diabetes mellitus; CAP: controlled attenuated parameter; DL: dyslipidemia; XL: large probe; AST: aspartate aminotransferase; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score; SD: standard deviation.

Patients (n)

135

Male (%)

Black (%)

Age^a

54 (12)

62 (10)

0.005

%BMI ≥ 30

%DM

%CAP > 263 dB/m

%DL

XL probe (%)

AST (IU/L)^a

31.6 (32.7)

30.8 (14.9)

ALT (IU/L)^a

29.48 (50.4)

26.2 (19.9)

Platelets (× 10³/mL)^a

218 (89)

203 (76)

APRI^a

0.35 (0.42)

0.34 (0.23)

%APRI > 1.5

FIB-4^a

1.89 (1.27)

2.28 (1.5)

%FIB-4 > 2.67

NFS^a

-0.560 (1.61)

0.138 (1.52)

0.021

%NFS > 0.675

0.007

**Table 4.** Comparison of Multiple Variables and Serum-Based Non-Invasive Models With Transient Elastography for Detection of Steatosis (CAP ≥ 263 dB/m)
Variables and models	CAP < 263 dB/m	CAP ≥ 263 dB/m	P values
^aMean ± SD. LS: liver stiffness (by transient elastography); BMI: body mass index; DM: diabetes mellitus; HTN: hypertension; CAP: controlled attenuated parameter; DL: dyslipidemia; XL: large probe; AST: aspartate aminotransferase; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score.
Patients (n)	126	43
Male (%)	64	65
Black (%)	57	61
Age^a	56 (13)	56 (9)
BMI (kg/m²)^a	27.8 (5.3)	32.2 (4.5)	< 0.0001
%BMI ≥ 30	27	64	< 0.0001
%DM	37	74	< 0.0001
%DL	58	54
%HTN	96	97
AST (IU/L)^a	33.8 (33.8)	24 (9)
ALT (IU/L)^a	31 (52)	21 (14)
%APRI > 1.5	2.5	0
FIB-4^a	2.12 (1.43)	1.54 (0.87)	0.017
%FIB-4 > 2.67	18	7
LS (kPa)^a	8.7 (7.8)	6.8 (3.9)
%LS ≥ 9 kPa	21	20
XL probe (%)	27	72	< 0.0001
NFS^a	0.0.43 (1.63)	-0.33 (1.59)
%NFS > 0.675	26	22

Table 4. Comparison of Multiple Variables and Serum-Based Non-Invasive Models With Transient Elastography for Detection of Steatosis (CAP ≥ 263 dB/m)

Variables and models

CAP < 263 dB/m

CAP ≥ 263 dB/m

P values

^aMean ± SD. LS: liver stiffness (by transient elastography); BMI: body mass index; DM: diabetes mellitus; HTN: hypertension; CAP: controlled attenuated parameter; DL: dyslipidemia; XL: large probe; AST: aspartate aminotransferase; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score.

Patients (n)

126

Male (%)

Black (%)

Age^a

56 (13)

56 (9)

BMI (kg/m²)^a

27.8 (5.3)

32.2 (4.5)

< 0.0001

%BMI ≥ 30

< 0.0001

%DM

< 0.0001

%DL

%HTN

AST (IU/L)^a

33.8 (33.8)

24 (9)

ALT (IU/L)^a

31 (52)

21 (14)

%APRI > 1.5

2.5

FIB-4^a

2.12 (1.43)

1.54 (0.87)

0.017

%FIB-4 > 2.67

LS (kPa)^a

8.7 (7.8)

6.8 (3.9)

%LS ≥ 9 kPa

XL probe (%)

< 0.0001

NFS^a

0.0.43 (1.63)

-0.33 (1.59)

%NFS > 0.675

**Table 5.** Characteristics Including Clinical, Laboratory, Non-Invasive Tests and Histologic Findings of Subjects Undergoing Liver Biopsy
Age (years)	Gender, M/F	Race, C/AA	BMI (kg/m²)	DM, Y/N	HTN, Y/N	DL, Y/N	ALT (U/L)	APRI	FIB-4	NFS	TE (kPa)	CAP (dB/m)	AF (F3 - 4)	Steatosis (≥ 5%)
^aRepresenting those with concordant APRI, FIB-4, NFS, or TE with histology for advanced fibrosis (AF) and steatosis. M: male; F: female; C: Caucasian; AA: African American; Y: yes; N: no; DM: diabetes mellitus; HTN: hypertension; DL: dyslipidemia; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score; TE: transient elastography; CAP: controlled attenuated parameter; AF: advanced fibrosis; N/A: not available.
60	F	AA	16.3	N	Y	N	178	2.38	5.35	-1.549^a	7.3^a	206^a	N^a	N^a
67	M	AA	27.1	N	Y	N	26	0.31^a	2.00^a	-0.716^a	3.9^a	302	N^a	N
63	M	AA	25.9	N	Y	Y	41	0.42	2.09	-1.026	21.6^a	251^a	Y^a	N^a
39	M	AA	26.1	N	Y	N	14	0.15^a	0.76^a	-2.219^a	5.9^a	203	N^a	N/A
65	F	C	32.3	Y	Y	Y	9	0.140^a	1.50^a	0.342^a	17.1	245^a	N	N^a
45	M	AA	26.4	Y	N	N	9	0.26^a	1.92^a	1.708	14.4	178^a	N	N^a
63	M	C	28.4	N	Y	N	42	0.52^a	2.54^a	-0.400^a	11.1	262	N	Y
56	M	C	24.4	N	Y	Y	167	2.76	5.98	-0.140^a	8.9^a	223^a	N^a	N^a
42	M	C	37.5	Y	Y	N	15	0.16^a	0.86^a	-0.448^a	16.2	340	N	N
66	F	C	21.6	N	Y	N	46	0.32	1.55	-2.236	26.3^a	100^a	Y^a	N^a
54	M	C	23.9	Y	Y	Y					26.3^a	173^a	Y^a	N^a
34	F	AA	29.7	N	Y	N	86	0.55^a	1.00^a	-1.946^a	6.6^a	100^a	N^a	N^a
51	F	C	28.3	N	Y	N	20	0.37	2.11	-0.477	23.9^a	334^a	Y^a	N
60	M	AA	40	Y	Y	N	15	0.16	1.24	0.751	21.3^a	248^a	Y^a	N^a

Table 5. Characteristics Including Clinical, Laboratory, Non-Invasive Tests and Histologic Findings of Subjects Undergoing Liver Biopsy

Age (years)

Gender, M/F

Race, C/AA

BMI (kg/m²)

DM, Y/N

HTN, Y/N

DL, Y/N

ALT (U/L)

APRI

FIB-4

NFS

TE (kPa)

CAP (dB/m)

AF (F3 - 4)

Steatosis (≥ 5%)

^aRepresenting those with concordant APRI, FIB-4, NFS, or TE with histology for advanced fibrosis (AF) and steatosis. M: male; F: female; C: Caucasian; AA: African American; Y: yes; N: no; DM: diabetes mellitus; HTN: hypertension; DL: dyslipidemia; ALT: alanine aminotransferase; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; NFS: non-alcoholic fatty liver disease fibrosis score; TE: transient elastography; CAP: controlled attenuated parameter; AF: advanced fibrosis; N/A: not available.

16.3

178

2.38

5.35

-1.549^a

7.3^a

206^a

N^a

27.1

0.31^a

2.00^a

-0.716^a

3.9^a

302

N^a

25.9

0.42

2.09

-1.026

21.6^a

251^a

Y^a

N^a

26.1

0.15^a

0.76^a

-2.219^a

5.9^a

203

N^a

N/A

32.3

0.140^a

1.50^a

0.342^a

17.1

245^a

N^a

26.4

0.26^a

1.92^a

1.708

14.4

178^a

N^a

28.4

0.52^a

2.54^a

-0.400^a

11.1

262

24.4

167

2.76

5.98

-0.140^a

8.9^a

223^a

N^a

37.5

0.16^a

0.86^a

-0.448^a

16.2

340

21.6

0.32

1.55

-2.236

26.3^a

100^a

Y^a

N^a

23.9

26.3^a

173^a

Y^a

N^a

29.7

0.55^a

1.00^a

-1.946^a

6.6^a

100^a

N^a

28.3

0.37

2.11

-0.477

23.9^a

334^a

Y^a

0.16

1.24

0.751

21.3^a

248^a

Y^a

N^a