Diagnostic Accuracy of FIB-4 and FIB-5 Scores as Compared to Fibroscan for Assessment of Liver Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease

Abstract

IntroductionLimited access/exorbitant cost of fibroscan and the associated risks with biopsy to assess fibrosis in nonalcoholic fatty liver disease (NAFLD) patients has made exigent demand of serum-based fibrosis scores to be validated for their accuracy and efficacy. The objective of the study was to compare the accuracy of FIB-4 (fibrosis-4) and FIB-5 (fibrofast) scores to rule out advanced fibrosis in NAFLD patients. MethodsA total of 145 patients were categorized as group I with mild/moderate fibrosis (MF) comprising of F0 to F2 and group II with advanced fibrosis (AF) comprising of F3 and F4 based on fibroscan kPa (kilopascal) score. ResultsGroup II had significantly higher alanine transaminase (ALT), aspartate transaminase (AST), haemoglobin % (Hb %), bilirubin and alkaline phosphatase (ALP) values and significantly lower platelet count and albumin as compared to group I. The FIB-4 score was significantly higher in group II [1.8 (1.1 -4.7)], as compared with group I [0.98 (0.63 -1.67)], p-value = 0.0001. FIB-5 score of group II [-6.4 (-8.8 -3.4)] was significantly lower as compared with group I [-4.8 (-6.8 -2.0)], p-value = 0.003. FIB-4 and FIB-5 had area under receiver operator characteristic (AUROC) curve of 0.712 and 0.655, respectively. FIB-4 at cut-off of <2.02 had a negative predictive value (NPV) of 90.7%. FIB-5 at a cut-off of <-7.11 has an NPV of 94.1% and at a cut-off of <-3.24 had an NPV of 88.9%. ConclusionWe concluded that both FIB-4 and FIB-5 can be used to rule out advanced fibrosis in NAFLD patients in a resource-limited and indigent setting as both the scores have NPV greater than 90%.

Fibrofast and Fibrosis-4 versus Fibroscan as Indicators of Hepatic Fibrosis in Non Alcholic Fatty Liver Disease Patients: A Cross-Sectional Study

“…Also agree with previous studies [22] that found FIB-4 has great potential in diagnosing liver fibrosis caused by viral hepatitis and NAFLD in patients with advanced fibrosis . This was in agreement with Kumari et al [23], who concluded that FIB-4 is one of the best indices to assess liver fibrosis in NAFLD patients [23].…”

“…We also found in our study; that the FIB-5 score has no significant difference between groups. This was in agreement with Kolhe et al, who stated that FIB 5 could not be used to rule out advanced fibrosis [28], but this is in contrast to the previous study [23] that reported the FIB-5 score of the group with advanced fibrosis was significantly lower as compared with patients with mild to moderate fibrosis in NAFLD patients.…”

The determination of the comparative effect of Ertugliflozin, Pioglitazone, and Metformin on patients of non-alcoholic fatty liver disease in type 2 diabetes mellitus.

“…Recent studies reported that a bro scan is the most accurate way to evaluate fatty liver, its grade, and brosis than liver biopsy as the gold standard (Foucher et al, 2006;Kumari et al, 2021). Other studies suggested that CAP is also preferred for the diagnosis of NAFLD (Group et al, 1996).…”

“…Additionally, the brosis-4 (FIB-4) index was measured using the formula. FIB-4 index = [age × AST (units/l)] / (-platelet count (× 109/l) × [ALT (units/l)]1/2 (Kumari et al, 2021). The FIB-4 index was classi ed into three categories such as low risk: <1.3, intermediate risk: 1.3-2.67, and high risk: >2.67 (Kumari et al, 2021).…”

“…FIB-4 index = [age × AST (units/l)] / (-platelet count (× 109/l) × [ALT (units/l)]1/2 (Kumari et al, 2021). The FIB-4 index was classi ed into three categories such as low risk: <1.3, intermediate risk: 1.3-2.67, and high risk: >2.67 (Kumari et al, 2021). We also calculated the APRI (aspartate aminotransferase to platelet ratio index) with the following formula: APRI = [(AST/AST/platelet (× 10 9 /l)] × 100.…”