Evidence map›Paper›PMID 35302256›Full record

ArticleAlimentary pharmacology & therapeutics2022

Comparison of clinical prediction rules for ruling out cirrhosis in nonalcoholic fatty liver disease (NAFLD).

Danielle Brandman, Marie Boyle, Stuart McPherson, Mark L Van Natta, Arun J Sanyal, Kris Kowdley, Brent Neuschwander-Tetri, Naga Chalasani, Manal F Abdelmalek, Norah A Terrault and 9 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Alimentary pharmacology & therapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Clinical Outcomes and Non-Invasive Testing in Metabolic Dysfunction-Associated Steatohepatitis With Cirrhosis: A Systematic Review.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Pooled it
  2. Article
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  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 14 institutions in 2 countries.

Danielle BrandmanDivision of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0003-3244-4696
Marie BoyleTranslational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Stuart McPhersonTranslational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-5638-2453
Mark L Van NattaJohn Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Arun J SanyalDepartment of Internal Medicine, Medical College of Virginia, Richmond, Virginia, USA.ORCID 0000-0001-8682-5748
Kris KowdleySwedish Medical Group, Seattle, Washington, USA.
Brent Neuschwander-TetriDivision of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA.
Naga ChalasaniDivision of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA.ORCID 0000-0003-4082-3178
Manal F AbdelmalekDivision of Gastroenterology, Hepatology, and Nutrition, Duke University, Durham, North Carolina, USA.
Norah A TerraultDivision of Gastroenterology and Liver, Keck Medicine, University of Southern California, Los Angeles, California, USA.ORCID 0000-0003-4143-1950
Art McCulloughDepartment of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
Ricki BettencourtNAFLD Research Center, Department of Medicine, University of California San Diego, San Diego, California, USA.
Cyrielle CaussyNAFLD Research Center, Department of Medicine, University of California San Diego, San Diego, California, USA.
David E KleinerLaboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Cynthia BehlingAnalytic Pathology Medical Group, Sharp Memorial Hospital, San Diego, California, USA.
James TonasciaJohn Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Quentin M AnsteeTranslational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-9518-0088
Rohit LoombaNAFLD Research Center, Department of Medicine, University of California San Diego, San Diego, California, USA.ORCID 0000-0002-4845-9991
Members of the Nonalcoholic Steatohepatitis Clinical Research Network
University of San Diego · USJohns Hopkins University · USNewcastle upon Tyne Hospital · GBCleveland Clinic · USDuke University · USIndiana University – Purdue University Indianapolis · USNational Institutes of Health · USNewcastle University · GBSaint Louis University · USSharp Memorial Hospital · USSwedish Medical Center · USUniversity of California, San Francisco · USUniversity of Southern California · USVirginia Commonwealth University Medical Center · US

Funding

WU INSTITUTE OF CLINICAL AND TRANSLATIONAL SCIENCESUL1TR002345 · NCATS · WASHINGTON UNIVERSITY · PI William G. Powderly · 2017 to 2026
$97.8M
UC San Diego Clinical and Translational Research InstituteUL1TR001442 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S, HOGARTH, MICHAEL · 2015 to 2024
$88.3M
Engaging University of California Stakeholders for Biorespository ResearchUL1TR000004 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$78.0M
Clinical and Translational Science Collaborative of ClevelandUL1TR000439 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI KONSTAN, MICHAEL W. · 2012 to 2016
$50.0M
Institute of Translational Health SciencesUL1TR000423 · NCATS · UNIVERSITY OF WASHINGTON · PI DISIS, MARY L. · 2012 to 2016
$49.4M
Washington University Institute of Clinical and Translational SciencesUL1TR000448 · NCATS · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2012 to 2016
$41.4M
Clinical and Translational Science Collaborative of ClevelandUL1TR002548 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI MCCOMSEY, GRACE A · 2018 to 2022
$35.5M
Pediatric Trials in Non-Alcoholic Steatohepatitis (NASH)U01DK061734 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI ROHIT LOOMBA · 2002 to 2026
$24.4M
Continuation of the Non-Alcoholic Steatohepatitis Clinical Research Network (NASHU01DK061730 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI TONASCIA, JAMES A · 2002 to 2018
$23.2M
San Diego Clinical and Translational Research InstituteUL1TR000100 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S · 2012 to 2015
$19.7M
Postmortem PathologyZICBC010685 · NCI · DIVISION OF BASIC SCIENCES - NCI · PI KLEINER, DAVID ERWIN · 2009 to 2025
$14.3M
Center for Clinical and Translational ResearchUL1TR000058 · NCATS · VIRGINIA COMMONWEALTH UNIVERSITY · PI MOELLER, FREDERICK GERARD · 2012 to 2015
$12.5M
Medical Research Council MR/V037331/1NCATS NIH HHS UL1 TR000004NCATS NIH HHS UL1 TR000006NCATS NIH HHS UL1 TR000058NCATS NIH HHS UL1 TR000100NCATS NIH HHS UL1 TR000423NCATS NIH HHS UL1 TR000436NCATS NIH HHS UL1 TR000439NCATS NIH HHS UL1 TR000448NCATS NIH HHS UL1 TR001442NCATS NIH HHS UL1 TR002345NCATS NIH HHS UL1 TR002548NIDDK NIH HHS U01 DK061713NIDDK NIH HHS U01 DK061718NIDDK NIH HHS U01 DK061728NIDDK NIH HHS U01 DK061730NIDDK NIH HHS U01 DK061731NIDDK NIH HHS U01 DK061732NIDDK NIH HHS U01 DK061734NIDDK NIH HHS U01 DK061737NIDDK NIH HHS U01 DK061738NIDDK NIH HHS U24 DK061730
6 · The paper itself

Abstract

BACKGROUND AND

aimsPatients with nonalcoholic fatty liver disease (NAFLD) cirrhosis benefit from referral to subspecialty care. While several clinical prediction rules exist to identify advanced fibrosis, the cutoff for excluding cirrhosis due to NAFLD is unclear. This analysis compared clinical prediction rules for excluding biopsy-proven cirrhosis in NAFLD.

methodsAdult patients were enrolled in the NASH Clinical Research Network (US) and the Newcastle Cohort (UK). Clinical and laboratory data were collected at enrolment, and a liver biopsy was taken within 1 year of enrolment. Optimal cutoffs for each score (eg, FIB-4) to exclude cirrhosis were derived from the US cohort, and sensitivity, specificity, positive predictive value, negative predictive value and AUROC were calculated. The cutoffs were evaluated in the UK cohort.

results147/1483 (10%) patients in the US cohort had cirrhosis. All prediction rules had similarly high NPV (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis (AUROC 0.84-0.86). 59/494 (12%) patients in the UK cohort had cirrhosis. Prediction rules had high NPV (0.92-0.96), and FIB-4 and NAFLD fibrosis score the most accurate in the prediction of cirrhosis in the UK cohort (AUROC 0.87-0.89).

conclusionsThis cross-sectional analysis of large, multicentre international datasets shows that current clinical prediction rules perform well in excluding cirrhosis with appropriately chosen cutoffs. These clinical prediction rules can be used in primary care to identify patients, particularly those who are white, female, and <65, unlikely to have cirrhosis so higher-risk patients maintain access to specialty care.

Indexed as

Non-alcoholic Fatty Liver DiseaseAdultBiopsyClinical Decision RulesCross-Sectional StudiesFemaleFibrosisHumansLiverLiver Cirrhosiscirrhosisnonalcoholic fatty liver diseasenoninvasive assessment

Identifiers

PMID35302256
PMCPMC9098681
OpenAlexW4221073102

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.