Letter: non‐invasive prediction models to exclude cirrhosis in NAFLD – not everyone fits the mould

Abstract

Editors,We read with great interest the recent article by Brandman et al. 1 comparing the clinical prediction rules for excluding biopsy-proven cirrhosis in nonalcoholic fatty liver disease (NAFLD) and defining new cut-offs. For all prediction rules, the authors reported comparable high negative predictive values (NPV) (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis in both the derivation as well as validation cohort, particularly those who are white, female and aged <65 years.However, there are a few issues that need to be addressed.

Multicenter validation of FIB-6 as a novel machine learning non-invasive score to rule out liver cirrhosis in biopsy-proven MAFLD

“…Recently, Brandman et al [23] compared 7 clinical prediction rules for ruling out cirrhosis in biopsy-proven NAFLD, they concluded that NAFLD fibrosis score and FIB-4 with a new cut-off of 1.67 were the most accurate for ruling out patients with cirrhosis in both derivation and validation cohorts (n = 1483) with sensitivity of 70% and 80% respectively. However, Giri et al [24], addressed several issues about their work; as the time interval between the laboratory test and liver biopsies was up to 1 year where multiple factors as diet or exercise could affect the degree of hepatic fibrosis and steatosis over a year. Moreover, number of patients with obesity or morbid obesity was not specified and it was previously mentioned that NAFLD fibrosis score overestimated advanced fibrosis in morbid obesity compared to conventional NAFLD patients [25].…”

Letter: non‐invasive prediction models to exclude cirrhosis in NAFLD—not everyone fits the mould. Authors' reply

“…We thank Giri et al for their interest in our recent manuscript. 1 They raised some interesting points regarding our study sample and the generalizability of our proposed cutoffs for FIB-4 and the NAFLD Fibrosis Score (NFS) in different patient populations. 2 We agree that nonalcoholic fatty liver disease (NAFLD) is a dynamic disease that can improve over time with dietary change, exercise and weight loss and that these changes may have occurred in the time interval between the liver biopsy and entry into the cohort.…”