Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease, is the most prevalent liver disorder worldwide. Historically, its diagnosis required biopsy, even though the procedure has a variable degree of error. Therefore, new non-invasive strategies are needed. Consequently, this article presents a thorough review of biopsy-free scoring systems proposed for the diagnosis of MAFLD. Similarly, it compares the severity of the disease, ranging from hepatic steatosis (HS) and nonalcoholic steatohepatitis (NASH) to fibrosis, by contrasting the corresponding serum markers, clinical associations, and performance metrics of these biopsy-free scoring systems. In this regard, defining MAFLD in conjunction with non-invasive tests can accurately identify patients with fatty liver at risk of fibrosis and its complications. Nonetheless, several biopsy-free scoring systems have been assessed only in certain cohorts; thus, further validation studies in different populations are required, with adjustment for variables, such as body mass index (BMI), clinical settings, concomitant diseases, and ethnic backgrounds. Hence, comprehensive studies on the effects of age, morbid obesity, and prevalence of MAFLD and advanced fibrosis in the target population are required. Nevertheless, the current clinical practice is urged to incorporate biopsy-free scoring systems that demonstrate adequate performance metrics for the accurate detection of patients with MAFLD and underlying conditions or those with contraindications of biopsy.
Highlights
Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is the most prevalent liver disorder worldwide [1, 2]
NAFLD can progress from steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and eventually, cirrhosis and hepatocellular carcinoma [10]
This novel biopsy-free scoring systems (BFSS) is based on age; albumin, AST, and glucose levels; homeostatic metabolic assessment, which positively correlated with a higher stage of liver fibrosis and stiffness [139]; insulin level; platelet count; sex; and type 2 diabetes mellitus (T2DM) [54, 140]
Summary
Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is the most prevalent liver disorder worldwide [1, 2]. This score has a limited value in predicting changes in fibrosis, even when it accurately predicts morbidity and mortality in all stages of fibrosis [138] This novel BFSS is based on age; albumin, AST, and glucose levels; homeostatic metabolic assessment, which positively correlated with a higher stage of liver fibrosis and stiffness [139]; insulin level; platelet count; sex; and T2DM [54, 140]. It has a high accuracy for advanced fibrosis exclusion [30], with a reported AUROC value of 0.94 for advanced fibrosis prediction [30]. In response to its low AUROC, they are considered unreliable alternatives for liver biopsy in MAFLD/NAFLD [157]
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