Validation of the BARD scoring system in Polish patients with nonalcoholic fatty liver disease (NAFLD)

Abstract

AbtractBackgroundNonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of liver diseases, ranging from pure steatosis to nonalcoholic steatohepatitis (NASH), and eventually to liver cirrhosis with its complications. Identifying advanced fibrosis in patients is crucial to evaluating prognosis and possible therapeutic intervention. A novel, simple, and highly accurate scoring system called BARD, which identifies patients with NAFLD and without significant fibrosis, has been recently introduced and validated in North America..The aim of this study is to validate the BARD scoring system in a Polish cohort with NAFLD.MethodsA group of 104 Caucasians with biopsy-proven NAFLD were included in this study. Fibrosis in liver biopsies was evaluated according to the Histological Scoring System for Nonalcoholic Fatty Liver Disease. The BARD scoring system was assessed according to Harrison et al.: BMI ≥ 28 = 1 point, AST/ALT ratio (AAR) ≥ 0.8 = 2 points, type 2 diabetes mellitus = 1point.ResultsAge over 50 and AAR over 0.8 showed, respectively, a moderate and strong association with advanced fibrosis. A BARD score of 2-4 points was associated with F3 or F4 stages of fibrosis with an odds ratio of 17.333 (95% Cl; 3,639 - 82.558) and negative predictive value of 97%.ConclusionOur results demonstrate that the BARD scoring system has value in the non-invasive diagnosis of advanced fibrosis in NAFLD patients. The vast majority of patients with NAFLD would avoid liver biopsy if BARD was broadly introduced into the clinic.

Development of Serum Marker Models to Increase Diagnostic Accuracy of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: The New LINKI Algorithm Compared with Established Algorithms

“…Thus, neither we nor Boursier et al [24] were able to confirm that the NAFLD fibrosis score is clinically useful to rule out advanced fibrosis in NAFLD. BARD [8] is simple to calculate in clinical practice and has previously been reported to perform well in order to exclude advanced fibrosis in NAFLD [25]. In our cohort we found an AUROC of 0.74 (95% CI 0.65–0.84), a fairly good NPV (0.89) but at the expense of a low PPV (0.36) and 41% of patients being misclassified.…”

Factors associated with advanced liver fibrosis in patients with non-alcoholic liver disease

“…Also, in the present study, females were predominant in the F3-F4 subgroup, showing a trend by the Fisher test (p = 0.08). In Harrison et al's study, women were overrepresented in the cohort of patients with NASH and advanced fibrosis; this was not confirmed in other studies and it has been suggested that there are no gender differences [8,13,14]. Further studies are required evaluating gender and, perhaps, ethnicity.…”

A composite model including visfatin, tissue polypeptide-specific antigen, hyaluronic acid , and hematological variables for the diagnosis of moderate-to-severe fibrosis in nonalcoholic fatty liver disease: a preliminary study

“…4,11 The BARD score including the BMI, AST/ALT ratio, and presence of diabetes was validated on a large sample of American patients with NAFLD, 8 but was also positively reevaluated in the Polish population with fatty liver. 32 The NFS incorporates 6 easily accessible variables and shows great accuracy for advanced fibrosis. It is the most extensively studied scoring system with external validation in 13 studies, involving more than 3000 patients.…”