{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T19:52:55Z","timestamp":1781121175612,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,10,4]],"date-time":"2018-10-04T00:00:00Z","timestamp":1538611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["634413"],"award-info":[{"award-number":["634413"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003783","name":"Graduate School of Excellence Materials Science In Mainz","doi-asserted-by":"publisher","award":["Institutional research grants"],"award-info":[{"award-number":["Institutional research grants"]}],"id":[{"id":"10.13039\/501100003783","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non\u2010alcoholic fatty liver disease (<jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content>). In contrast to cirrhosis, advanced, non\u2010cirrhotic <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> is difficult to identify and data from Germany are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify clinical factors associated with advanced, non\u2010cirrhotic fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were recruited in the prospectively enrolling European <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> Registry. Clinical characteristics and the performance of non\u2010invasive surrogate scores compared with vibration\u2010controlled transient elastography are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and sixty\u2010one patients with non\u2010cirrhotic <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> on liver biopsy (mean age 51\u00a0years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50\u00a0years, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01), had a higher body mass index (32.3 vs 30.5, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05), and more frequent arterial hypertension (78% vs 50%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and type 2 diabetes (61% vs 24.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). On multivariate logistic regression, diabetes (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a04.68, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.17\u201010.10) and hypertension (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a02.91, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.12\u20107.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an <jats:styled-content style=\"fixed-case\">AUROC<\/jats:styled-content> of 0.81 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.72\u20100.91). The performance of <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> fibrosis score, Fibrosis\u20104, and <jats:styled-content style=\"fixed-case\">AST<\/jats:styled-content> to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The prevalence of metabolic comorbidities in a German population with non\u2010cirrhotic biopsy\u2010proven <jats:styled-content style=\"fixed-case\">NAFLD<\/jats:styled-content> is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood\u2010based non\u2010invasive surrogate scores in ruling out advanced fibrosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14976","type":"journal-article","created":{"date-parts":[[2018,10,6]],"date-time":"2018-10-06T04:04:09Z","timestamp":1538798649000},"page":"1109-1116","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":96,"title":["Predictors of advanced fibrosis in non\u2010cirrhotic non\u2010alcoholic fatty liver disease in Germany"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8390-9663","authenticated-orcid":false,"given":"Christian","family":"Labenz","sequence":"first","affiliation":[{"name":"Department of Medicine I University Medical Center of the Johannes Gutenberg\u2010University Mainz 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Gutenberg\u2010University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate K.","family":"Straub","sequence":"additional","affiliation":[{"name":"Institute of Pathology University Medical Center of the Johannes Gutenberg\u2010University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R.","family":"Galle","sequence":"additional","affiliation":[{"name":"Department of Medicine I University Medical Center of the Johannes Gutenberg\u2010University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus\u2010Alexander","family":"W\u00f6rns","sequence":"additional","affiliation":[{"name":"Department of Medicine I University Medical Center of the Johannes Gutenberg\u2010University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin M.","family":"Anstee","sequence":"additional","affiliation":[{"name":"Institute of Cellular Medicine Faculty of Medical Sciences 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