Document Detail

Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease.
MedLine Citation:
PMID:  20801772     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Accurate evaluation of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is important to identify patients who may develop complications. The aim of this study was to compare the diagnostic performance of simple non-invasive tests in identifying advanced fibrosis among patients with biopsy-proven NAFLD. METHODS: Consecutive patients with biopsy proven NAFLD were recruited from the Newcastle Hospitals Fatty Liver Clinic from 2003 to 2009. The AST/ALT ratio, AST to platelet ratio index, BARD (weighted sum of BMI>28=1 point, AST/ALT ratio>0.8=2 points, diabetes=1 point), FIB-4 (agexAST (IU/l)/platelet count (x10(9)/litre)x radicalALT (IU/l)) and NAFLD fibrosis scores were calculated from blood tests taken at time of biopsy. RESULTS: 145 patients (82 male (61%), mean age 51+ or -12 years) were included. The mean body mass index was 35+ or -5 kg/m(2). 73 subjects (50%) had diabetes. 93 patients (64%) had non-alcoholic steatohepatitis. 27 (19%) had advanced fibrosis (Kleiner stage 3-4). The FIB-4 score had the best diagnostic accuracy for advanced fibrosis (area under receiver operator characteristic curve (AUROC) 0.86), followed by AST/ALT ratio (AUROC 0.83), NAFLD fibrosis score (AUROC 0.81), BARD (AUROC 0.77) and AST to platelet ratio index (AUROC 0.67). The AST/ALT ratio, BARD score, FIB-4 and NAFLD fibrosis scores had negative predictive values greater than 90% (93%, 95%, 95% and 92% respectively). Positive predictive values were modest. In order to exclude advanced fibrosis liver biopsy could potentially be avoided in 69% with AST/ALT ratio, 62% with FIB-4, 52% with NAFLD fibrosis score and 38% with BARD. CONCLUSIONS: The ALT/AST ratio, FIB-4 and NAFLD fibrosis scores can reliably exclude advanced fibrosis in a high proportion of patients with NAFLD, allowing liver biopsy to be used in a more directed manner.
Stuart McPherson; Stephen F Stewart; Elsbeth Henderson; Alastair D Burt; Christopher P Day
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gut     Volume:  59     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-30     Completed Date:  2010-10-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  1265-9     Citation Subset:  AIM; IM    
Liver Unit, Level 6, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
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MeSH Terms
Alanine Transaminase / blood
Aspartate Aminotransferases / blood
Biological Markers / blood
Epidemiologic Methods
Fatty Liver / complications*,  pathology
Liver Cirrhosis / diagnosis*,  etiology*,  pathology
Middle Aged
Reg. No./Substance:
0/Biological Markers; EC Aminotransferases; EC Transaminase

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