External Validation of Serologic Scores for the Detection of Liver Steatosis Among People With HIV

• Published in: Open forum infectious diseases 2024-09, Vol.11 (9), p.ofae411
• Main Authors: Riebensahm, Carlotta, Brocker, Julia, Berzigotti, Annalisa, Günthard, Huldrych F, Tarr, Philip E, Furrer, Hansjakob, Rauch, Andri, Wandeler, Gilles, Surial, Bernard
• Format: Article
• Language: English
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae411

Abstract Background Fatty liver index (FLI) and hepatic steatosis index (HSI) are serologic scores used to detect liver steatosis. However, their diagnostic performance in people with HIV (PWH) remains unclear. We performed an external validation of FLI and HSI in the Swiss HIV Cohort Study. Methods We systematically performed vibration-controlled transient elastography (VCTE) among Swiss HIV Cohort Study participants at Bern University Hospital between November 2019 and August 2021. Individuals with viral hepatitis and pregnant women were excluded. We defined liver steatosis as controlled attenuation parameter ≥248 dB/m using VCTE. Model discrimination was assessed with the C-index and model calibration with calibration plots. A decision curve analysis was performed to compare the clinical usefulness of both scores. Results Of 321 participants, 91 (28.4%) were female, the median age was 51.4 years (IQR, 42–59), 230 (71.7%) were Caucasian, and 164 (51.1%) had a body mass index >25 kg/m2. VCTE-confirmed liver steatosis was present in 158 (49.2%). Overall, 125 (38.9%) had an FLI ≥60, and 128 (39.9%) had an HSI ≥36. At these cutoffs, the C-index to diagnose liver steatosis was 0.85 for FLI (95% CI, .80–.89) and 0.78 for HSI (95% CI, .73–.83). Whereas FLI was well calibrated, HSI overestimated the risk for steatosis. Both models showed a positive net benefit, with FLI having a greater net benefit when compared with HSI. Conclusions FLI and HSI are valid tools to detect liver steatosis in PWH. FLI should be the preferred score, given its better performance and greater clinical usefulness. Graphical Abstract Graphical Abstract This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/external-validation-of-serological-scores-for-the-detection-of-liver-steatosis-among-people-with-hiv-open-forum-infectious-diseases-6598b433-21db-43bb-881d-508733d014b8 Liver steatosis is common in people with HIV. Fatty liver index and hepatic steatosis index are valid scores based on clinical and laboratory variables to detect liver steatosis in people with HIV and allow a targeted approach to screening.