The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD

Abstract

Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n ‫؍‬ 480) and validate (n ‫؍‬ 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (؊1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%). Conclusion: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients. (HEPATOLOGY 2007;45:846-854.)

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

“…NAFLD fibrosis score has demonstrated high sensitivity and specificity to predict the risk of fibrosis, but requires an algorithm, including several parameters (both clinical and laboratory) [4]. No single conventional US parameter has demonstrated so far, a full reliability to predict fibrous tissue in NAFLD patients.…”

“…In the last years, some clinical/laboratory scores have been created to assess the risk of NASH evolution and the need of biopsy in these patients [1]. Among all, NALFD fibrosis score seems to predict well the presence of significant fibrosis [4][5][6]. Although the traditional ultrasound (US) is an excellent diagnostic technique to reveal the presence of diffuse fatty liver disease, it is neither sensitive nor specific to reveal fibrosis, except in advanced stages where signs of cirrhosis are evident.…”

Can aspirin resistance be clinically predicted in stroke patients?

“…To be sure, the higher the ALT levels, the higher the risk of NAFLD [19]. However, these criteria do not necessarily overlap.…”

Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies

“…NAFLD fibrosis score,26 BMI, AST/ALT ratio, diabetes (BARD) score,27 Göteborg University cirrhosis index (GUCI) score,28 fibrosis‐4 (FIB‐4) score,29 and AST to platelet ratio index (APRI) score30 were calculated using biochemical and clinical data.…”