Abstract
Background
Liver biopsy is the criterion standard to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), which is important for prognosis, whereas noninvasive scoring systems showing promise for predicting fibrotic status include aspartate/alanine aminotransferase (AST/ALT) ratio, BARD score, fibrosis–4-score (FIB-4), and the NAFLD Fibrosis Score (NFS).
Objectives
To determine the accuracy of noninvasive scoring systems to predict advanced fibrosis in Thai patients with NAFLD.
Methods
A prospective cross-sectional study of Thai patients with liver biopsy-proven NAFLD during January 2009-October 2012 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Baseline NFS, BARD, and FIB-4 calculations were used to distinguish patients with NAFLD with and without advanced liver fibrosis, using cutoffs for NFS ≥ -1.455, BARD ≥ 2, and FIB-4 >1.3 (http://gihep.com/calculators/hepatology/).
Results
We included 139 patients mean age 40.95 (SD 13.3) years (47% male). Impaired fasting glucose or diabetes mellitus was found in 75, 9 showed advanced fibrosis (≥F3) by liver histology. NFS with cutoff ≥ -1.455 was determined as the best system with the highest sensitivity for identifying patients with advanced fibrosis, followed by BARD ≥2, FIB-4 >1.45, and AST/ALT ratio >0.8. Liver biopsy could potentially be avoided in >38% of patients with BARD, 46% with NFS, 64% with AST/ALT ratio, and 81% with FIB-4.
Conclusions
Advanced fibrosis was prevalent in 6% of our Thai patients with NAFLD. NFS had the highest negative predictive value for excluding patients with advanced fibrosis. At least 38% of patients with NAFLD could avoid liver biopsy by using the BARD system.