Validation model of fibrosis-8 index score to predict significant fibrosis among patients with nonalcoholic fatty liver disease

Abstract

BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease (NAFLD) management. The fibrosis-8 (FIB-8) score, recently developed by incorporating four additional variables into the fibrosis-4 (FIB-4) score, showed better performance in predicting significant fibrosis in NAFLD. AIM To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score (NFS) for predicting significant fibrosis. METHODS We collected the data of biopsy-proven NAFLD patients from three Asian centers in three countries. All the patients with available variables for the FIB-4 score (age, platelet count, and aspartate and alanine aminotransferase levels) and FIB-8 score (the FIB-4 variables plus 4 additional parameters: The body mass index (BMI), albumin to globulin ratio, gamma-glutamyl transferase level, and presence of diabetes mellitus) were included. The fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria, and significant fibrosis was defined as at least fibrosis stage 2. RESULTS A total of 511 patients with biopsy-proven NAFLD and complete data were included for validation. Of these 511 patients, 271 (53.0%) were female, with a median age of 51 (interquartile range: 41, 58) years. The median BMI was 29 (26.3, 32.6) kg/m 2 , and 268 (52.4%) had diabetes. Among the 511 NAFLD patients, 157 (30.7%) had significant fibrosis (≥ F2). The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774, 0.743, and 0.680, respectively. The FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS ( P = 0.001) and was also clinically superior to FIB-4, although statistical significance was not reached ( P = 0.073). The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36% sensitivity, and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.77 showed 67.51% specificity. CONCLUSION We demonstrated that the FIB-8 score had significantly better performance for predicting significant fibrosis in NAFLD patients than the NFS, as well as clinically superior performance vs the FIB-4 score in an Asian population. A novel simple fibrosis score comprising commonly accessible basic laboratories may be beneficial to use for an initial assessment in primary care units, excluding patients with significant liver fibrosis and aiding in patient selection for further hepatologist referral.

A Comparison of the Prognostic Value of Liver Fibrosis Scores in Acute Myocardial Infarction Patients With and Without Type 2 Diabetes

“…10 Besides, a recent study involving Asian patients with biopsyproven NAFLD, who have similar age distributions as well as a similar prevalence of diabetes compared with the above Western cohort, indicated that the FIB-8 score performed better than the NFS and the FIB-4 score for predicting significant fibrosis. 19 It is still unknown which liver fibrosis scores perform better for prognostic prediction in Asians with AMI. In the present study, we found that the NFS showed the highest predictive value for all-cause mortality and cardiac death than the FIB-8 and the FIB-4 scores.…”

“…12 FIB-8 = FIB-4 + 0.025 × BMI (kg/m 2 ) –0.702 × (albumin/globulin ratio) + 0.004 × gamma-glutamyl transpeptidase (U/L) + 0.858 × diabetes (yes = 1, no = 0). 19 Based on the cutoff values from previous literature, 14,19 patients were divided into low, intermediate, and high-risk categories (i.e., −1.455 and 0.676 for the NFS, 1.3 and 2.67 for the FIB-4 score, 0.88 and 1.77 for the FIB-8 score, respectively).…”

“…10,18 Recently, the FIB-8 score was developed on the basis of the FIB-4 score and showed a better predictive value than the NFS and the FIB-4 score for significant fibrosis. 19 However, the prognostic value of these scores has not been compared in AMI patients with and without diabetes. This study aims to examine and compare the prognostic performance of the NFS, the FIB-8, and the FIB-4 scores in AMI patients with and without diabetes who underwent PCI.…”

Non-invasive assessment of metabolic dysfunction–associated fatty liver disease

“…FIB-8 was shown to have AUROC of 0.77 with sensitivity and specificity of 92.4% (using lower cut-off of 0.88) and 67.5% (using higher cut-off of 1.77), respectively. 67 …”

“…Recently, Prasoppokakorn et al reported on the Fibrosis-8 (FIB-8) score [the FIB-4 variables plus BMI, albumin to globulin ratio, serum gamma glutamyl transpeptidase (GGT) level and the presence of T2DM] for the diagnosis of significant fibrosis using data of biopsy-proven NAFLD patients from three Asian centers (Thailand, Hong Kong, and Malaysia). FIB-8 was shown to have AUROC of 0.77 with sensitivity and specificity of 92.4% (using lower cut-off of 0.88) and 67.5% (using higher cut-off of 1.77), respectively 67.…”