Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population

Abstract

BackgroundA reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) is expected to be useful for evaluating hepatic fibrosis. We validated the performance of FIB4 index in a Japanese cohort with NAFLD.MethodsThe areas under the receiver operating characteristic curves (AUROC) for FIB4 and six other markers were compared, based on data from 576 biopsy-proven NAFLD patients. Advanced fibrosis was defined as stage 3-4 fibrosis. FIB4 index was assessed as: age (yr) × AST (IU/L)/(platelet count (109/L) × √ALT (IU/L))ResultsAdvanced fibrosis was found in 64 (11%) patients. The AUROC for FIB4 index was superior to those for the other scoring systems for differentiating between advanced and mild fibrosis. Only 6 of 308 patients with a FIB4 index below the proposed low cut-off point (< 1.45) were under-staged, giving a high negative predictive value of 98%. Twenty-eight of 59 patients with a FIB4 index above the high cut-off point (> 3.25) were over-staged, giving a low positive predictive value of 53%. Using these cutoffs, 91% of the 395 patients with FIB-4 values outside 1.45-3.25 would be correctly classified. Implementation of the FIB4 index in the Japanese population would avoid 58% of liver biopsies.ConclusionThe FIB4 index was superior to other tested noninvasive markers of fibrosis in Japanese patients with NAFLD, with a high negative predictive value for excluding advanced fibrosis. The small number of cases of advanced fibrosis in this cohort meant that this study had limited power for validating the high cut-off point.

Comparison between FIB-4 Index and Fibroscan as Marker of Fibrosis in Chronic HCV Infection in Egyptian Patients

“…This was in agreement with (Sumida et al, 2012) [21] who conducted this study upon Japanese nonalcoholic fatty liver disease population. This contradict with Sterling et al, 2006 [10] who found that there was statistically significant difference between mild (Ishak score 0 -1), moderate (Ishak score 2 -3) and severe fibrosis (Ishak score 4 -6) as regard the ALT.…”

“…Claiming that the age has been used in the past-in the absence of knowledge of exact time of disease onset-as a surrogate marker of disease duration and has been associated with more advanced fibrosis [20]. It also contradicts with Sumida et al, 2012 [21].…”

Impact of fatty liver disease and metabolic syndrome on incident type 2 diabetes; a population based cohort study

“…We used fib-4 index [43] as a marker for liver fibrosis. Among 3,846 participants with fatty liver disease, 9.2% (355 participants) were indeterminate range (FIB-4 index 1.30-2.67) and 0.3% (13 participants) were high-risk (FIB-4 index >2.67).…”

Background of the FIB-4 Index in Japanese Non-Alcoholic Fatty Liver Disease

“…Sumida et al (12) diagnosed the state of fibrosis in liver biopsies of 576 Japanese patients with NAFLD, and investigated whether such staging could be evaluated with the FIBstudy, the cut-off points for the FIB-4 index was categorized as low at <1.45, indeterminate at 1.45-3.25, and high at >3.25. Compared with other scoring systems, these values were found to be useful for distinguishing between mild and severe fibrosis, with a reported negative predictive value of 98% and positive predictive value of 53%.…”