Diagnosis and Characterization of Non-Alcoholic Fatty Liver Disease Based on Artificial Intelligence.
Diagnosis and Characterization of Non-Alcoholic Fatty Liver Disease Based on Artificial Intelligence.
A key element in the diagnosis of non-alcoholic fatty liver disease (NAFLD) is the
 differentiation of non-alcoholic steatohepatitis (NASH) from non-alcoholic fatty liver (NAFL)
 and the staging of the liver fibrosis, given that patients with NASH and advanced fibrosis
 are those at greatest risk of developing hepatic complications and cardiovascular disease.
 There are still no available non-invasive methods that allow for correct diagnosis and
 staging of NAFLD. The implementation of Artificial Intelligence (AI) techniques based on
 artificial neural networks and deep learning systems (Deep Learning System) as a tool for
 medical diagnoses represents a bona fide technological revolution that introduces an
 innovative approach to improving health processes.
The objectives of this observational study are the following:

 1. To design a predictive model of significant liver disease due to NAFLD, based on
 clustering or clustering algorithms (AI)

 2. To apply and validate this model to classify patients according to the severity of the
 disease in such a manner as to provide more effective management of these patients from
 Primary Care to Hospital Care through process and resource optimization

 3. To develop a Deep Learning System based on convolutional neuronal networks for automatic
 recognition of images in a cohort of subjects with digitized liver biopsies, and to
 undertake pairwise analysis that allows for correct and exact classification of biopsies
 from subjects with NASH.

 Design:

 An observational study of the determination and validation of diagnostic predictive models of
 NAFLD.

 The study has four phases:

 Phases I and II refer to both unsupervised and supervised artificial intelligence learning to
 identify clusters and build diagnostic algorithms. They will be carried out on data generated
 from the ETHON cohort (see below).

 Phase III will consist on applying deep learning system technology as a support strategy to
 stratify liver biopsies in NALFD patients according to their grade of necro-inflammation and
 stage of fibrosis. Liver biopsies collected in the Spanish registry of NAFLD up to the
 beginning of the study will be used.

 Finally, a phase IV of validation will be performed with data from patients that are going to
 be registered in the Spanish registry of NAFLD.

 Population:

 1. - Study cohort (Phases I-III):

 A. Subjects from the general population identified in the ETHON (Epidemiological Study
 of Hepatic Infections) cohort* that has already been created (12,246 subjects between
 19-74 years of age) and B. Subjects belonging to the Spanish registry of NAFLD (HEPAmet)
 (1,800 subjects already collected at the beginning of the study)

 *The ETHON cohort was recruited between 2015 and 2017 to study the hepatitis C
 prevalence in the Spanish general population aged 19-74 years old. Lavin AC, Llerena S,
 Gomez M, Escudero MD, Rodriguez L, Estebanez LA, Gamez B, Puchades L, Cabezas J, Serra
 MA, Calleja JL, Crespo J. Prevalence of hepatitis C in the spanish population. The
 PREVHEP study (ETHON cohort). J Hepatol. 2017;66:S272.

 2. - Validation cohort (Phase IV):

 Patients diagnosed with NAFLD by hepatic biopsy recruited in the Spanish and European
 registers from the beginning of the study.

 -Inclusion and exclusion criteria:

 Inclusion criteria: subjects aged 19-74 belonging to the ETHON cohort or registered in the
 Hepamet Spanish registry of NAFLD or the European NAFLD registry

 Exclusion criteria: subjects that not fulfill the inclusion criteria and those who did not
 sign informed consent to participate in the ETHON cohort or to be registered in the mentioned
 registers.
Inclusion Criteria:

 -  Subjects aged 19-74 belonging to the ETHON cohort or registered in the Hepamet Spanish
 registry of NAFLD or the European NAFLD registry

 Exclusion Criteria:

 -  Subjects that not fulfill the inclusion criteria and those who did not sign informed
 consent to participate in the ETHON cohort or to be registered in the mentioned
 registers.