The Validation of Conventional Non-Invasive Fibrosis Scoring Systems in Patients with Metabolic Associated Fatty Liver Disease

Abstract

Background：Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD). This study evaluated the diagnostic performance of four non-invasive scores including AST to platelet ratio index (APRI), fibrosis-4 index (FIB-4), BMI, AST/ALT ratio, and diabetes score (BARD), and NAFLD fibrosis score(NFS) in patients with MAFLD.Methods: Consecutive patients with histologically-confirmed MAFLD were included. The discrimination ability of different non-invasive scores was compared.Results: A total of 417 patients were included, 156 (37.4%) of them had advanced fibrosis (METAVIR ≥F3). The area under receiver operating characteristic curve (AUROC) of FIB-4, NFS, APRI and BARD for predicting advanced fibrosis were 0.736, 0.724, 0.671 and 0.609 respectively. The AUROC between FIB-4 and NFS were similar (P=0.523), while the difference between FIB-4 and APRI (P=0.001) and FIB-4 and BARD (P<0.001) was statistically significant. The best thresholds of FIB-4，NFS，APRI and BARD for diagnosis of advanced fibrosis in MAFLD were 1.05, -2.1, 0.42 and 2. A subgroup analysis showed that FIB-4, APRI and NFS performed worse in pure MAFLD than HBV-MAFLD group.Conclusions: APRI and BARD score do not perform well in MAFLD. The FIB-4 and NFS could be more useful but new threshold is needed. Novel non-invasive scoring system for fibrosis is required for MAFLD.

Screening for MAFLD: who, when and how?

“… 62 Of the non-invasive blood tests, FIB-4 and NFS mostly outperformed the other scoring systems (namely, APRI and BARD, which stands for BMI, AST/ALT ratio and presence of T2DM) for both MAFLD and NAFLD. 63 , 64 Even though these two tests can be used with confidence in overweight, obese and severely obese patients, their performance in lean and morbidly obese patients was found to be questionable. 65 …”

Epidemiology, natural history, and diagnosis of metabolic dysfunction-associated fatty liver disease: a comparative review with nonalcoholic fatty liver disease

“…68,69 It is generally accepted that FIB-4 and NFS are superior to APRI and BARD in both MAFLD and NAFLD populations. [70][71][72][73] On analyzing a cohort of 417 patients with biopsy-proven MAFLD, Wu et al 70 Although the use of FIB-4 and NFS should be preferred over other panels for the screening of advanced fibrosis, their application in patients with MAFLD is not without limitations. First, their main clinical utility lies in their ability to exclude -rather than identify -advanced fibrosis.…”

“…68,69 It is generally accepted that FIB-4 and NFS are superior to APRI and BARD in both MAFLD and NAFLD populations. 70–73 On analyzing a cohort of 417 patients with biopsy-proven MAFLD, Wu et al 70 reported that FIB-4 was characterized by the highest area under curve (0.736; 95% CI: 0.691−0.778) followed by NFS (0.724; 95% CI: 0.679−0.767), APRI (0.671; 95% CI: 0.623−0.715), and BARD (0.609; 95% CI: 0.560−0.656).…”