Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease

World J Gastroenterol. 2021 Sep 14;27(34):5753-5763. doi: 10.3748/wjg.v27.i34.5753.


Background: Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD).

Aim: To evaluate the diagnostic performance of four non-invasive scores including aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD), and nonalcoholic fatty liver disease 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 of FIB-4, NFS, APRI, and BARD for predicting advanced fibrosis was 0.736, 0.724, 0.671, and 0.609, respectively. The area under receiver operating characteristic curve of FIB-4 and NFS was 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 the pure MAFLD group than in the hepatitis B virus-MAFLD group.

Conclusion: APRI and BARD scores do not perform well in MAFLD. The FIB-4 and NFS could be more useful, but a new threshold is needed. Novel non-invasive scoring systems for fibrosis are required for MAFLD.

Keywords: Aspartate aminotransferase to platelet ratio index; BARD; Fibrosis-4 index; Metabolic associated fatty liver disease; Non-alcoholic fatty liver disease fibrosis score; Non-invasive fibrosis scores.

MeSH terms

  • Biopsy
  • Humans
  • Liver Cirrhosis / diagnosis
  • Non-alcoholic Fatty Liver Disease* / complications
  • Non-alcoholic Fatty Liver Disease* / diagnosis
  • Platelet Count
  • Predictive Value of Tests