Abstract
BackgroundA reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) is expected to be useful for evaluating hepatic fibrosis. We validated the performance of FIB4 index in a Japanese cohort with NAFLD.MethodsThe areas under the receiver operating characteristic curves (AUROC) for FIB4 and six other markers were compared, based on data from 576 biopsy-proven NAFLD patients. Advanced fibrosis was defined as stage 3-4 fibrosis. FIB4 index was assessed as: age (yr) × AST (IU/L)/(platelet count (109/L) × √ALT (IU/L))ResultsAdvanced fibrosis was found in 64 (11%) patients. The AUROC for FIB4 index was superior to those for the other scoring systems for differentiating between advanced and mild fibrosis. Only 6 of 308 patients with a FIB4 index below the proposed low cut-off point (< 1.45) were under-staged, giving a high negative predictive value of 98%. Twenty-eight of 59 patients with a FIB4 index above the high cut-off point (> 3.25) were over-staged, giving a low positive predictive value of 53%. Using these cutoffs, 91% of the 395 patients with FIB-4 values outside 1.45-3.25 would be correctly classified. Implementation of the FIB4 index in the Japanese population would avoid 58% of liver biopsies.ConclusionThe FIB4 index was superior to other tested noninvasive markers of fibrosis in Japanese patients with NAFLD, with a high negative predictive value for excluding advanced fibrosis. The small number of cases of advanced fibrosis in this cohort meant that this study had limited power for validating the high cut-off point.
Highlights
A reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD)
Type 2 diabetes mellitus is associated with nonalcoholic fatty liver disease (NAFLD) in clinical practice
NAFLD includes a wide spectrum of liver diseases ranging from simple steatosis, which is usually a benign and non-progressive condition, to nonalcoholic steatohepatitis (NASH), which can progress to liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in the absence of significant alcohol consumption [1,2,3,4]
Summary
A reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). The FIB4 index was developed as a noninvasive panel to stage liver disease in subjects with human immunodeficiency virus and hepatitis C virus (HCV) co-infection [22]. It relies on patient age, AST, ALT, and platelet count, which are routinely measured and are available for virtually all subjects with liver disease. This index has been independently validated in subjects with HCV infection alone [23]. We aimed to assess the accuracy of the FIB4 index for predicting advanced liver fibrosis in a cohort of Japanese patients with NAFLD
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