Comparison of Fibroscan to Simple Noninvasive Screening Tools in Predicting Fibrosis in NAFLD Patients of Western India With High Risk of Liver Fibrosis

Abstract

The study is aimed to determine the efficacy of Fibroscan as compared to noninvasive markers, NAFLD Fibrosis Score (NFS), APRI (AST/Platelet ratio) and AAR (AST/ALT ratio) as a screening tool in NAFLD patients with high risk of liver fibrosis. This is a single center study carried out in patients attending OPD for dyspepsia and diagnosed as fatty liver on ultrasound. Liver biopsy was advised in diabetics, metabolic syndrome, BMI>30kg/m2, raised transaminases and hypothyroidism. Fibroscan, APRI, AAR and NFS were calculated. AUROC, NPV, PPV was calculated for each diagnostic test. Of 1,500 patients screened, 110 with above described risk factors underwent liver biopsy (72 had F Stage 0/1/2 fibrosis, 38 showed stage 3/4 Fibrosis). Diabetes predicted severe fibrosis (stage 3/4) as compared to mild disease. The sensitivity, specificity, PPV, NPV and AUROC for Fibroscan at value 12 kPa was 0.9, 0.8, 0.70, 0.93 and 0.91, respectively, for predicting stage 3/4 fibrosis. With increase in severity of liver fibrosis there was step wise increase in Fibroscan values (P = .000038, Kruskal–Wallis test). The sensitivity, specificity, PPV and NPV for AAR and NFS at cutoff of 1.5 and 0.676 is 0.8, 1.0, 1.0 and 0.92 and 0.8, 1.0, 1.0 and 0.92 respectively. Fibroscan, NFS and AAR are simple noninvasive markers of fibrosis that can be utilized as a screening tool in patients with high risk for fibrosis to determine the need for biopsy. The cutoff of Fibroscan for stage 3/4 fibrosis was 12 kPa.