Noninvasive fibrosis tools in NAFLD: validation of APRI, BARD, FIB-4, NAFLD fibrosis score, and Hepamet fibrosis score in a Portuguese population

ABSTRACT

Objectives

The burden of nonalcoholic fatty liver disease (NAFLD) is increasing, with an estimated prevalence in Europe of 20–30%. Although most patients present with simple steatosis, some progress to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. Definite diagnosis and staging require liver biopsy, which is not feasible given the high prevalence of NAFLD. As such, several noninvasive tools have been formulated. However, to date, none have been validated in the Portuguese population. The aim of this study was to determine the diagnostic accuracy of the aspartate aminotransferase to platelet ratio (APRI), the BMI, AST/ALT ratio and Diabetes (BARD), the FIB-4 Index (FIB-4), the Hepamet fibrosis score (HFS), and the NAFLD fibrosis score (NFS) in a Portuguese population.

Methods

A retrospective review of liver biopsies from two hospital centers was performed. Patients with NAFLD and no decompensated cirrhosis, liver cancer, or terminal illness were included. APRI, BARD, FIB-4, HFS, and NFS were calculated for each patient.

Results

A total of 121 individuals were included, of which 21.5% had advanced fibrosis (F ≥ 3). There was a moderate or high correlation between most tools. The negative predictive factor (NPV) and area under receiver operating curve (AUROC) were 89.9% and 0.80 for APRI, 91.8% and 0.84 for BARD, 95.7% and 0.88 for FIB-4, 96.4% and 0.88 for HFS, and 93.0% and 0.86 for NFS, respectively.

Conclusion

The tools analyzed had excellent performance (AUROC ≥ 0.80) and were adequate for ruling out advanced fibrosis (NPV ≥ 89.9%) in a Portuguese population. As such, they are adequate for use in clinical practice or as a part of referral and follow-up programs wherever this population is treated.

Abbreviations

APRI – aspartate aminotransferase to platelet ratio, ALT – alanine aminotransferase, AST – aspartate aminotransferase, BARD – BMI, AST/ALT ratio and Diabetes, BMI – body mass index, FIB-4 – FIB-4 index, HCC – hepatocellular carcinoma, HFS – Hepamet fibrosis score, HOMA-IR – homeostatic model assessment for insulin resistance, IQR – interquartile range, MAFLD – metabolic associated fatty liver disease, NAFLD – nonalcoholic fatty liver disease, NASH – nonalcoholic steatohepatitis, NFS – NAFLD fibrosis score, OMIC – genomics, transcriptomics, proteomics, and metabolomics, T2DM – type 2 diabetes mellitus

KEYWORDS:

• nonalcoholic fatty liver disease
• fibrosis
• liver cirrhosis
• diagnostic accuracy
• validation study

Conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The data that support the findings of this study are available from the corresponding author, J.R., upon reasonable request.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.