Comparison of FibroScan-Aspartate Aminotransferase (FAST) Score and Other Non-invasive Surrogates in Predicting High-Risk Non-alcoholic Steatohepatitis Criteria

Abstract

Identification of non-alcoholic steatohepatitis (NASH) with high activity and fibrosis is a major priority in patients with non-alcoholic fatty liver disease. We validated the predictive value of the FibroScan-aspartate aminotransferase (FAST) score and other non-invasive fibrosis surrogates in predicting high-risk NASH criteria. This multicenter retrospective study recruited 251 biopsy-proven non-alcoholic fatty liver disease (NAFLD) patients (132 [52.6%] men) between 2011 and 2014. The FAST score was calculated using transient elastography data and aspartate aminotransferase (AST) levels. The NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and AST to platelet ratio index (APRI) were calculated using biochemical data. The area under the receiver operating characteristic curves (AUCs) of the FAST score, liver stiffness, NFS, FIB-4, and APRI were 0.752, 0.718, 0.609, 0.650, and 0.722 for NAFLD activity score (NAS) ≥5 (n = 117, 46.6%); 0.788, 0.754, 0.649, 0.701, and 0.747 for fatty liver inhibition of progression-NASH with histologic activity ≥3 (n = 202, 80.5%); 0.807, 0.806, 0.691, 0.732, and 0.760 for severe disease with activity ≥3 and/or fibrosis ≥3 (n = 132, 52.6%); and 0.714, 0.812, 0.748, 0.738, and 0.669 for NASH with NAS ≥4 and fibrosis ≥2 (n = 70, 27.9%), respectively. The FAST score had the highest AUC for the most high-risk NASH criteria, except for in predicting NAS ≥4 and fibrosis ≥2. The liver stiffness value showed consistently acceptable performance in predicting all high-risk NASH criteria. The FAST score has acceptable performance in identifying high-risk NASH. However, liver stiffness alone was not inferior to the FAST score.

Pemafibrate improves liver dysfunction and non-invasive surrogates for liver fibrosis in patients with non-alcoholic fatty liver disease with hypertriglyceridemia: a multicenter study

“…3 , 4 ). Lee et al demonstrated that FAST score and APRI were significantly involved in the degree of fibrosis and steatosis [ 29 ]. This report supports our data that pemafibrate might improve liver function and fibrosis.…”

Suboptimal Performance of Hepatocellular Carcinoma Prediction Models in Patients with Hepatitis B Virus-Related Cirrhosis

“…In the current era of potent AVT where the virologic effects can be easily suppressed, most of the recently established systems adopted the presence of baseline cirrhosis or fibrotic burden, and generally demonstrated high negative predictive values to exclude HCC development within about 10 years [38]. However, because cirrhosis itself is a strong predictor [39], the predictive power of the proposed models is expected to decrease somewhat in the cirrhosis group, which has a common fibrotic burden [40].…”

Non-alcoholic fatty liver disease: Immunological mechanisms and current treatments

“…FAST™ performed better than other non-invasive algorithms for the diagnosis of at-risk NASH[ 104 , 105 ]. Results have shown that the FAST score had the highest area under curve for the most high-risk NASH criteria as well as liver stiffness showing a consistently acceptable performance in predicting NASH[ 106 ].…”