FIB-4, APRI, and NFS Scores Compared to FibroScan for the Assessment of Liver Fibrosis in Patients with NAFLD

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Background: NAFLD is a spectrum of liver disease ranging from fatty liver to steatohepatitis, fibrosis and cirrhosis. Due to the epidemic proportion of individuals with NAFLD worldwide, liver biopsy evaluation is impractical, and noninvasive assessment for the diagnosis of NASH and fibrosis is needed. In this study we aimed to compare FIB-4, APRI, and NFS score to FibroScan for the assessment of hepatic fibrosis in patients with NAFLD. Methods: This prospective study included 103 patients with NAFLD and was conducted in the Hepato-Gastroenterology Unit of Functional Digestive Explorations at CHU Ibn SINA in RABAT MOROCCO and covers the period from 01/2016 to 04/2023. A checklist was used to record the demographic features and biological data of the patients. Then, all patients underwent FibroScan using the FibroScan compact 530 device (Echosens, France). Results: Of the 103 patients with NAFLD included in this study, with a mean age of 54.4 ± 11.4 years, 35(34%) were male and 68 (66%) were female. Based on FibroScan results, 58 patients (56.3%) were classified as F1, 13 (12.6%) as F2, 5 (4.9 %) as F3, and 27 (26.2 %) as F4. A significant correlation was found between FibroScan and FIB-4 (r = 0.365), APRI (r = 0.376), and NFS score (r = 0.356) (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of APRI at the 0.64 cut-off for the differentiation of F3F4 from F2F1 were 59.4, 84.5, 63.3, 82.2 and 76.7%. FIB-4 at the 1.8 cut-off 68.8, 83.1, 64.7, 85.5, 78.6% and NFS at the 0.89 cut-off 71.9, 69, 51.1, 84.5 and 69.9% respectively. Moreover, the area under the receiver operating curve of APRI, FIB-4, and NFS for the differentiation of F3F4 from F1F2 was 0.782, 0.779, and 0.723, respectively. Conclusions: Based on these results, APRI appears to be the most appropriate substitute of FibroScan for the detection of significant fibrosis in NAFLD patients.