Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice

Table 2 Biomarker panels for diagnosing nonalcoholic fatty liver disease related fibrosis

Test	Description	Accuracy	Advantages	Disadvantages	Guideline recommendation
APRI	AST/platelet ratio index	AUROC 0.70 for SF, 0.75 for AF, and 0.75 for cirrhosis[28]	High feasibility; Cheap; Reproducible	Low specificity to diagnose AF; The application of two cut-offs could not discriminate between intermediate stages of fibrosis	NA
Fibrosis-4 index	Age, AST, ALT, and platelet count	AUROC 0.75 for SF, 0.80 for AF, and 0.85 for cirrhosis[28]	High feasibility; Cheap; Reproducible	The application of two cut-offs could not discriminate between intermediate stages of fibrosis; Influenced by age	FIB-4 can be used to identify those at low or high risk for AF or cirrhosis [32,34]
NFS	Age, BMI, impaired fasting glucose and/or diabetes, AST, ALT, platelet, Count, and albumin	AUROC 0.72 for SF, 0.73 for AF, and 0.83 for cirrhosis [28]	High feasibility; Cheap; Reproducible	The application of two cut-offs could not discriminate between intermediate stages of fibrosis; Influenced by age; Influenced by interpretation of BMI across different ethnic groups	NFS can be used to identify those at low or high risk for AF or cirrhosis[32]
BARD score	AST, ALT, BMI, and diabetes	AUROC 0.64 for SF, 0.73 for AF, and 0.70 for cirrhosis[28]	High feasibility; Cheap; Reproducible; No intermediate stages of fibrosis	Low specificity to diagnose SF and cirrhosis; Influenced by interpretation of BMI across different ethnic groups	NA

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; AUROC: Area under the receiver-operating characteristics curve; NFS: Nonalcoholic fatty liver disease fibrosis score; APRI: AST/platelet ratio index; NA: Not applicable; SF: Significant fibrosis; AF: Advanced fibrosis.