Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5753
Peer-review started: January 6, 2021
First decision: May 5, 2021
Revised: May 15, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 14, 2021
Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD).
To evaluate the diagnostic performance of four non-invasive scores including aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD), and nonalcoholic fatty liver disease fibrosis score (NFS) in patients with MAFLD.
Consecutive patients with histologically confirmed MAFLD were included. The discrimination ability of different non-invasive scores was compared.
A total of 417 patients were included; 156 (37.4%) of them had advanced fibrosis (Metavir ≥ F3). The area under receiver operating characteristic curve of FIB-4, NFS, APRI, and BARD for predicting advanced fibrosis was 0.736, 0.724, 0.671, and 0.609, respectively. The area under receiver operating characteristic curve of FIB-4 and NFS was similar (P = 0.523), while the difference between FIB-4 and APRI (P = 0.001) and FIB-4 and BARD (P < 0.001) was statistically significant. The best thresholds of FIB-4, NFS, APRI, and BARD for diagnosis of advanced fibrosis in MAFLD were 1.05, -2.1, 0.42, and 2. A subgroup analysis showed that FIB-4, APRI, and NFS performed worse in the pure MAFLD group than in the hepatitis B virus-MAFLD group.
APRI and BARD scores do not perform well in MAFLD. The FIB-4 and NFS could be more useful, but a new threshold is needed. Novel non-invasive scoring systems for fibrosis are required for MAFLD.
Core Tip: Metabolic associated fatty liver disease (MAFLD) is a new concept proposed in 2020 to redefine fatty liver disease. The utility of non-invasive fibrosis scores as well as their optimal thresholds for MAFLD remains unknown. We validated the conventional non-invasive scores including aspartate aminotransferase to platelet ratio index, fibrosis-4 index, body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score, and nonalcoholic fatty liver disease fibrosis score in patients with MAFLD. The results indicate that the conventional scores may lead to a high rate of misdiagnosis in MAFLD. A novel scoring system for fibrosis is urgently needed.