Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Researchers have tried to develop indices to assess liver fibrosis in NAFLD patients to avoid liver biopsy. In this study we aimed to compare fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio with FibroScan for the assessment of hepatic fibrosis in patients with NAFLD.MethodsThis cross-sectional study included patients with NAFLD or non-alcoholic steatohepatitis (NASH) referred to the Gastroenterology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, in 2019. Demographic features of the participants including age and gender were recorded. All participants underwent FibroScan and had their AST, ALT, and platelet count measured in a random blood sample, taken within 1 month of the FibroScan.ResultsOf the 205 NAFLD patients included in this study with a mean age of 42.95 ± 10.97 years, 144 (70.2%) were male. Fibroscan results revealed that 94 patients (45.9%) had F1, 67 (32.7%) F2, 29 (14.1%) F3, and 15 (7.3%) F4 liver fibrosis. A significant correlation was found between FibroScan score and FIB-4 (r = 0.572), APRI (r = 0.667), and AST/ALT (r = 0.251) (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of APRI at the 0.702 cut-off for the differentiation of F3 and F4 from F2 and F1 were 84.1, 88.2, 66.1, 95.3, and 87.3%, FIB-4 at the 1.19 cut-off 97.7, 72.7, 49.4, 99.2 and 78%, and AST/ALT at the 0.94 cut-off 61.4, 77, 42.2, 87.9, and 73.7% respectively. Moreover, the area under the receiver operating curve of APRI, FIB-4, and AST/ALT for the differentiation of F3 and F4 from F2 and F1 was 0.923, 0.913, and 0.720, respectively.ConclusionsBased on these results, APRI appears to be the most appropriate substitute of FibroScan for the detection of significant fibrosis in NAFLD patients. FIB-4 was the second best, suggesting that in case of FibroScan unavailability, APRI and FIB-4 are the best indices to assess liver fibrosis in NAFLD patients.
Highlights
With an estimated prevalence of approximately 25%, non-alcoholic fatty liver disease (NAFLD) is considered an increasing public health problem, owing to its close association with type 2 diabetes mellitus, obesity, and metabolic syndrome, as well as their undeniableAmernia et al BMC Gastroenterology (2021) 21:453 epidemics worldwide [1,2,3]
To FibroScan for the assessment of hepatic fibrosis in patients with Non-alcoholic fatty liver disease (NAFLD). Participants This cross-sectional study included patients with NAFLD or non-alcoholic steatohepatitis (NASH) diagnosed based on US findings or liver enzymes by an expert gastroenterologist according to the recommendations of the EASL, the European Association for the Study of Diabetes (EASD), and the European Association for the Study of Obesity (EASO) [17], who were referred to the Gastroenterology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, during 2019
A significant correlation was found between FibroScan score and FIB-4 (r = 0.572), Aspartate aminotransferase (AST) to platelet ratio index (APRI) (r = 0.667), and AST/Alanine aminotransferase (ALT) ratio (r = 0.251) (P < 0.001)
Summary
With an estimated prevalence of approximately 25%, non-alcoholic fatty liver disease (NAFLD) is considered an increasing public health problem, owing to its close association with type 2 diabetes mellitus, obesity, and metabolic syndrome, as well as their undeniableAmernia et al BMC Gastroenterology (2021) 21:453 epidemics worldwide [1,2,3]. With an estimated prevalence of approximately 25%, non-alcoholic fatty liver disease (NAFLD) is considered an increasing public health problem, owing to its close association with type 2 diabetes mellitus, obesity, and metabolic syndrome, as well as their undeniable. NAFLD is a spectrum of liver diseases, from fatty infiltration to steatohepatitis, fibrosis, and cirrhosis [5]. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Researchers have tried to develop indices to assess liver fibrosis in NAFLD patients to avoid liver biopsy. In this study we aimed to compare fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio with FibroScan for the assessment of hepatic fibrosis in patients with NAFLD
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