The first external validation of the Dallas steatosis index in biopsy-proven Non-alcoholic fatty liver Disease: A multicenter study

• Published in: Diabetes research and clinical practice 2023-09, Vol.203, p.110870-110870, Article 110870
• Main Authors: Kouvari, Matina, Mylonakis, Sophia C., Katsarou, Angeliki, Valenzuela-Vallejo, Laura, Guatibonza-Garcia, Valentina, Kokkorakis, Michail, Verrastro, Ornella, Angelini, Giulia, Markakis, Georgios, Eslam, Mohammed, George, Jacob, Papatheodoridis, Georgios, Mingrone, Geltrude, Mantzoros, Christos S.
• Format: Article
• Language: English
• Subjects: Liver fibrosis; Liver steatosis; Net-benefit analysis; Non-invasive tool; Validation study
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2023.110870

A new non-invasive tool (NIT) for non-alcoholic fatty liver disease (NAFLD) proposed in 2022 by the multi-ethnic Dallas Heart Study, i.e. the Dallas Steatosis Index (DSI), was validated herein using for the first time the gold standard i.e. liver biopsy-proven NAFLD. This is a multicenter study based on samples and data from two Gastroenterology-Hepatology Clinics (Greece and Australia) and one Bariatric-Metabolic Surgery Clinic (Italy). Overall, n = 455 patients with biopsy-proven NAFLD (n = 374) and biopsy-proven controls (n = 81) were recruited. The ability of DSI to correctly classify participants as NAFLD or controls was very good, reaching an Area Under the Curve (AUC) = 0.887. The cut-off point that could best differentiate the presence vs. absence of NAFLD corresponded to DSI = 0.0 (risk threshold: 50% | Sensitivity: 0.88; Positive Predictive Value (PPV): 93.0%; F1-score = 0.91). DSI demonstrated significantly better performance characteristics than other liver steatosis indexes. Decision curve analysis revealed that the benefit of DSI as a marker to indicate the need for invasive liver assessment was confirmed only when higher DSI values, i.e. ≥ 1.4, were used as risk thresholds. DSI performance to differentiate disease progression was inadequate (all AUCs