Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease

Simple item page
dc.contributor.authorMcPherson, S.
dc.contributor.authorStewart, S.
dc.contributor.authorHenderson, E.
dc.contributor.authorBurt, A.
dc.contributor.authorDay, C.
dc.date.issued2010
dc.description.abstractBACKGROUND Accurate evaluation of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is important to identify patients who may develop complications. The aim of this study was to compare the diagnostic performance of simple non-invasive tests in identifying advanced fibrosis among patients with biopsy-proven NAFLD. METHODS Consecutive patients with biopsy proven NAFLD were recruited from the Newcastle Hospitals Fatty Liver Clinic from 2003 to 2009. The AST/ALT ratio, AST to platelet ratio index, BARD (weighted sum of BMI>28=1 point, AST/ALT ratio>0.8=2 points, diabetes=1 point), FIB-4 (age×AST (IU/l)/platelet count (×109/litre)×√ALT (IU/l)) and NAFLD fibrosis scores were calculated from blood tests taken at time of biopsy. RESULTS 145 patients (82 male (61%), mean age 51±12 years) were included. The mean body mass index was 35±5 kg/m2. 73 subjects (50%) had diabetes. 93 patients (64%) had non-alcoholic steatohepatitis. 27 (19%) had advanced fibrosis (Kleiner stage 3–4). The FIB-4 score had the best diagnostic accuracy for advanced fibrosis (area under receiver operator characteristic curve (AUROC) 0.86), followed by AST/ALT ratio (AUROC 0.83), NAFLD fibrosis score (AUROC 0.81), BARD (AUROC 0.77) and AST to platelet ratio index (AUROC 0.67). The AST/ALT ratio, BARD score, FIB-4 and NAFLD fibrosis scores had negative predictive values greater than 90% (93%, 95%, 95% and 92% respectively). Positive predictive values were modest. In order to exclude advanced fibrosis liver biopsy could potentially be avoided in 69% with AST/ALT ratio, 62% with FIB-4, 52% with NAFLD fibrosis score and 38% with BARD. CONCLUSIONS The ALT/AST ratio, FIB-4 and NAFLD fibrosis scores can reliably exclude advanced fibrosis in a high proportion of patients with NAFLD, allowing liver biopsy to be used in a more directed manner.
dc.description.statementofresponsibilityStuart McPherson, Stephen F Stewart, Elsbeth Henderson, Alastair D Burt, Christopher P Day
dc.identifier.citationGut, 2010; 59(9):1265-1269
dc.identifier.doi10.1136/gut.2010.216077
dc.identifier.issn0017-5749
dc.identifier.issn1468-3288
dc.identifier.orcidBurt, A. [0000-0002-3011-7774]
dc.identifier.urihttp://hdl.handle.net/2440/82794
dc.language.isoen
dc.publisherBritish Med Journal Publ Group
dc.rights© 2010, BMJ Publishing Group Ltd and the British Society of Gastroenterology
dc.source.urihttps://doi.org/10.1136/gut.2010.216077
dc.subjectHumans
dc.subjectFatty Liver
dc.subjectLiver Cirrhosis
dc.subjectAlanine Transaminase
dc.subjectAspartate Aminotransferases
dc.subjectBiopsy
dc.subjectEpidemiologic Methods
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectBiomarkers
dc.titleSimple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease
dc.typeJournal article
pubs.publication-statusPublished

Files

Collections

Medicine publications