Meta-analysis: Enhanced liver fibrosis test to identify hepatic fibrosis in chronic liver diseases.

BACKGROUND & AIMS: Patients with liver disease can be stratified for risk of liver-related ill health by degree of hepatic fibrosis. The Enhanced liver fibrosis (ELF) test was developed to quantify hepatic fibrosis non-invasively and is widely used. The objective of this review was to identify and synthesise the evidence on the diagnostic accuracy of the ELF test for staging of hepatic fibrosis. APPROACH & RESULTS: Searches of PubMed and EMBASE were conducted between October 2020 and November 2021 to identify studies reporting the diagnostic accuracy of the ELF test compared to histology in liver disease patients. QUADAS-2 was used to assess risk of bias in each study. Meta-analysis using the multiple thresholds model described by Steinhauser S, Schumacher M, Rücker G. Modelling multiple thresholds in meta-analysis of diagnostic test accuracy studies. BMC Med. Res. Methodol. 2016;16. 10.1186/s12874-016-0196-1 allowed synthesis of 2 × 2 data at different cut-offs. Sixty-three studies were included in this review. These studies included 19,285 patients with or at risk of liver disease from viral hepatitis, Non-Alcoholic Fatty Liver Disease, Alcohol-related Liver Disease and other mixed chronic liver diseases. The prevalence of significant fibrosis, advanced fibrosis and cirrhosis was 47.5%, 39.2% and 4.4%, respectively. Cut-offs with maximal Youden index were generated with AUROC = 0.811 (95% CI: 0.736-0.870), 0.812 (95% CI: 0.758-0.856) and 0.810 (95% CI: 0.694-0.888) to detect significant fibrosis, advanced fibrosis or cirrhosis, respectively. Diagnostic accuracy of the ELF test varied between different liver diseases and cut-offs to detect each stage with 95% sensitivity or specificity were also generated. CONCLUSIONS: Meta-analysis revealed considerable variability in the ability of ELF to stage fibrosis across disease aetiologies. Research has mostly focused on viral hepatitis and NAFLD. There is currently a lack of data on the value of the ELF test in Alcohol-related liver disease and patients in primary care settings.

Association Between Motor Subtype and Visuospatial and Executive Function in Mild-Moderate Parkinson Disease.

OBJECTIVE: To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN: Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING: Assessments took place at Emory University. PARTICIPANTS: Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS: Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS: Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.