Assessment of Feasibility, Patient Acceptance, and Performance of Point-of-Care Ultrasound-Based Transient Elastography for Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Authors: Das Taranika Sarkar , Abdallah Mohamed , Bilal Mohammad , Sarwar Raiya , Shaukat Aasma 
Published: May 2024

Abstract

Background: Vibration Controlled Transient Elastography (VCTE) using FibroScan serves as a non-invasive and dependable diagnostic approach for Non-alcoholic Fatty Liver Disease (NAFLD), which is globally recognized as the most prevalent chronic liver condition. It allows for the early detection and management of NAFLD and Non-alcoholic Steatohepatitis (NASH), effectively preventing the progression to severe liver diseases. The ease of use and portability of VCTE make it highly suitable for widespread adoption in primary care and community settings, thereby facilitating large-scale screening for liver health. The integration of VCTE into point-of-care settings could streamline referrals, promote lifestyle interventions, reduce healthcare costs, and notably benefit underserved communities. Point-of-care VCTE demonstrates comparable diagnostic accuracy for detecting steatosis. The rationale for opting for point-of-care testing over standard laboratory testing is influenced by the presence of trained personnel at labs, which could potentially impact quality, coupled with constraints on conducting bulk VCTE tests within the existing framework. Given that most labs are situated in urban areas with limited accessibility, necessitating patients to take time off, conducting point-of-care testing in GI clinics or PCP offices emerges as a more practical option. Our study aimed to assess the diagnostic accuracy of VCTE for detecting fibrosis and steatosis in point-of-care settings.
Methods: A comprehensive literature search identified studies reporting on point-of-care VCTE. Meta-analysis was conducted using a random-effects model, and results were presented in terms of pooled proportions alongside relevant 95% confidence intervals. Heterogeneity was assessed using I2%.
Results: The analysis encompassed data from 11,665 patients across 31 studies. For diagnosing fibrosis stage ≥F1, the respective summary Area Under the Receiver Operating Characteristic Curve (sAUROC), pooled sensitivity, and specificity were 0.76, 67.7%, and 77.2%. For stage ≥F2 (significant fibrosis), they were 0.78, 78.2%, and 71.44%, respectively. For stage ≥F3 (advanced fibrosis), they were 0.87, 86%, and 72.9%. For stage =F4 (cirrhosis), they were 0.87, 89.3%, and 73.4%. Point-of-care VCTE demonstrated similar diagnostic accuracy for steatosis.
VCTE's compliance rate was found to be 93.4%, surpassing rates observed for MRI-Proton Density Fat Fraction (MRI-PDFF). Patient preference studies favored VCTE over liver biopsy, especially in regions where the latter is publicly funded, with patients often willing to cover VCTE costs themselves. However, there is a noted decline in follow-up engagement over time, highlighting the need for strategies to maintain long-term adherence to VCTE monitoring, which can potentially be improved through the integration of point-of-care VCTE with doctor's appointments.
Conclusion: VCTE exhibits high diagnostic accuracy for detecting fibrosis and steatosis in patients with NAFLD in point-of-care settings. Future studies should focus on evaluating the implementation of point-of-care fibroscans