Diagnostic performance of three non-invasive fibrosis scores (Hepamet, FIB-4, NAFLD fibrosis score) in NAFLD patients from a mixed Latin American population

Zambrano-Huailla, Rommel; Guedes, Laura Vilar; Stefano, José Tadeu; Souza, Arthur A. Arrais de; Marciano, Sebastián; Yvamoto, Erika Yuki; Michalczuk, Matheus Truccolo; Vanni, Denise Siqueira; Rodriguez, Hernan; Carrilho, Flair José; Álvares‐da‐Silva, Mário Reis; Gadano, Adrián; Arrese, Marco; Miranda, Adelina Lozano; Oliveira, Conceição Maria de

doi:10.1016/j.aohep.2020.08.066

Cited by 37 publications

(22 citation statements)

References 22 publications

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“…Table 1 summarizes advantages and limitations of each approach that have been extensively reviewed elsewhere [35]. In addition, recent studies have pinpointed that thresholds of non-invasive fibrosis scores, such as Hepamet, FIB-4, and NFS, can be modified according to the ethnicity of patients with NAFLD with the aim of reaching maximal diagnostic accuracy [47]. In addition, liver fibrosis biomarkers such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (ARR), AST to platelet ratio index (APRI), Fibrosis-4 (FiB-4), Forns index, NAFLD fibrosis score (NFS), BARD (body mass index (BMI), AAR, diabetes) score, and Hepamet fibrosis score (HFS) can rule out advanced fibrosis and are positively correlated with cardiovascular risk (CVR) scores in patients with NAFLD [48].…”

Section: Diagnosismentioning

confidence: 99%

Perspectives on Precision Medicine Approaches to NAFLD Diagnosis and Management

Lonardo¹,

Arab

Arrese

2021

Adv Ther

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Precision medicine defines the attempt to identify the most effective approaches for specific subsets of patients based on their genetic background, clinical features, and environmental factors. Nonalcoholic fatty liver disease (NAFLD) encompasses the alcohol-like spectrum of liver disorders (steatosis, steatohepatitis with/without fibrosis, and cirrhosis and hepatocellular carcinoma) in the nonalcoholic patient. Recently, disease renaming to MAFLD [metabolic (dysfunction)-associated fatty liver disease] and positive criteria for diagnosis have been proposed. This review article is specifically devoted to envisaging some clues that may be useful to implementing a precision medicine-oriented approach in research and clinical practice. To this end, we focus on how sex and reproductive status, genetics, intestinal microbiota diversity, endocrine and metabolic status, as well as physical activity may interact in determining NAFLD/ MAFLD heterogeneity. All these factors should be considered in the individual patient with the aim of implementing an individualized therapeutic plan. The impact of considering NAFLD heterogeneity on the development of targeted therapies for NAFLD subgroups is also extensively discussed.

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Section: Diagnosismentioning

confidence: 99%

Perspectives on Precision Medicine Approaches to NAFLD Diagnosis and Management

Lonardo¹,

Arab

Arrese

2021

Adv Ther

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“…Recently, there has been an increased search for non-invasive scores to diagnose the stage of NAFLD fibrosis ( 9 – 12 ). Many of the fibrosis scores have been developed and validated in large studies on adult with NAFLD, and are part of routine clinical practice, including the AST/Platelet Index (APRI), FIB-4 score, and NAFLD Fibrosis Score (NFS) ( 11 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

et al. 2022

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IntroductionNon-alcoholic fatty liver disease (NAFLD) is a multifaceted disease that includes a wide spectrum of liver damage. The presence and the degree of fibrosis are considered important factors for the prognosis of NAFLD and in predicting the risk of developing cirrhosis. Our aim was to evaluate the usefulness of four fibrosis scores (aspartate aminotransferase/Platelet Index [APRI], FIB-4, NAFLD Fibrosis Score [NFS], and Hepamet) in predicting different degrees of fibrosis among children with biopsy-proven NAFLD.MethodsAbout 286 adolescents [mean age 14.3 years ± 2.5; 154 (53.6%) males], referred between January 2014 and December 2019, with biopsy-proven NAFLD were enrolled.ResultsAbout 173 (60.4%) patients presented fibrosis at histological analysis. In particular: 140 (49.3%) patients had F = 1, 31 (10.8%), had F = 2 and 2 (0.66%) had F = 3. APRI (AUROC 0.619, 95% CI 0.556–0.679) and Hepamet (AUROC 0.778, 95% CI 0.722–0.828) scores had significant (p < 0.001) accuracy to distinguish subjects with fibrosis; while NFS and FIB-4 had not. APRI had a positive predictive value (PPV) of 62.77% (95% CI 57.96–67.35) and an negative predictive value (NPV) of 52.01% (95% CI 46.54–57.43); Hepamet a PPV of 63.24% (95% CI 59.95–66.41) and an NPV of 61.29% (52.9–69.01).ConclusionsOur study showed that Hepamet and APRI perform better than NFS and FIB-4 for identifying fibrosis in patients with NAFLD, but do not have PPVs so high to be considered diagnostic. Therefore, they cannot be employed, in children, for a certain diagnosis of fibrosis or its progression and cannot replace liver biopsy as the gold diagnostic standard. It is, therefore, necessary to continue to research and develop new markers of exclusive fibrosis.

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“…Certain BFSSs underperformed in validation studies, such as the BAAT score ( 168 ), Nice model ( 59 , 60 ), OW liver test ( 61 , 62 ), NASH score ( 63 ), CHeK model ( 165 ), or GlycoNASH test ( 64 ), making them unsuitable alternatives for MAFLD/NAFLD diagnosis; thus, they were consequently excluded from the scrutiny of this review. Comprehensive studies on the effects of age, BMI, obesity, and the prevalence rates in different populations ( 101 , 140 , 148 , 169 ) are required to determine the role of current and future BFSSs in MAFLD/NAFLD diagnosis. Other non-invasive alternatives have been proposed recently, such as cell-free DNA, which has been found in extracellular vesicles in the serum of patients with fatty liver, and have yielded promising results ( 170 ).…”

Section: Discussionmentioning

confidence: 99%

“…This novel BFSS is based on age; albumin, AST, and glucose levels; homeostatic metabolic assessment, which positively correlated with a higher stage of liver fibrosis and stiffness ( 139 ); insulin level; platelet count; sex; and T2DM ( 54 , 140 ). It has a high accuracy for advanced fibrosis exclusion ( 30 ), with a reported AUROC value of 0.94 for advanced fibrosis prediction ( 30 ).…”

Section: Hepatic Fibrosis Scoring Systemsmentioning

confidence: 99%

MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis

2022

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Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease, is the most prevalent liver disorder worldwide. Historically, its diagnosis required biopsy, even though the procedure has a variable degree of error. Therefore, new non-invasive strategies are needed. Consequently, this article presents a thorough review of biopsy-free scoring systems proposed for the diagnosis of MAFLD. Similarly, it compares the severity of the disease, ranging from hepatic steatosis (HS) and nonalcoholic steatohepatitis (NASH) to fibrosis, by contrasting the corresponding serum markers, clinical associations, and performance metrics of these biopsy-free scoring systems. In this regard, defining MAFLD in conjunction with non-invasive tests can accurately identify patients with fatty liver at risk of fibrosis and its complications. Nonetheless, several biopsy-free scoring systems have been assessed only in certain cohorts; thus, further validation studies in different populations are required, with adjustment for variables, such as body mass index (BMI), clinical settings, concomitant diseases, and ethnic backgrounds. Hence, comprehensive studies on the effects of age, morbid obesity, and prevalence of MAFLD and advanced fibrosis in the target population are required. Nevertheless, the current clinical practice is urged to incorporate biopsy-free scoring systems that demonstrate adequate performance metrics for the accurate detection of patients with MAFLD and underlying conditions or those with contraindications of biopsy.

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Diagnostic performance of three non-invasive fibrosis scores (Hepamet, FIB-4, NAFLD fibrosis score) in NAFLD patients from a mixed Latin American population

Cited by 37 publications

References 22 publications

Perspectives on Precision Medicine Approaches to NAFLD Diagnosis and Management

Perspectives on Precision Medicine Approaches to NAFLD Diagnosis and Management

Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis

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