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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Validation model of fibrosis-8 index score to predict significant fibrosis among patients with nonalcoholic fatty liver disease
Thaninee Prasoppokakorn, Wah-Kheong Chan, Vincent Wai-Sun Wong, Panyavee Pitisuttithum, Sanjiv Mahadeva, Nik Raihan Nik Mustapha, Grace Lai-Hung Wong, Howard Ho-Wai Leung, Pimsiri Sripongpun, Sombat Treeprasertsuk
Thaninee Prasoppokakorn, Sombat Treeprasertsuk, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Wah-Kheong Chan, Sanjiv Mahadeva, Department of Medicine, Division of Gastroenterology, Division of Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Panyavee Pitisuttithum, Department of Medicine, Division of General Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Nik Raihan Nik Mustapha, Department of Pathology, Hospital Sultanah Bahiyah, Alor Setar, Kedah 05460, Malaysia
Howard Ho-Wai Leung, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
Pimsiri Sripongpun, Department of Internal Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
Pimsiri Sripongpun, Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA 94305, United States
Author contributions: Treeprasertsuk S designed the study; Pitisuttithum P, Chan WK, Wong VWS, and Treeprasertsuk S contributed to data acquisition; Mahadeva S and Wong GLH recruited and managed the patients; Mustapha NRN and Leung HHW performed the histological assessment; Prasoppokakorn T, Pitisuttithum P, Sripongpun P, and Treeprasertsuk S analyzed and interpreted the data; Prasoppokakorn T drafted the manuscript; Chan WK, Sripongpun P, Wong VWS, and Treeprasertsuk S revised the manuscript critically for important intellectual content; all the authors read and approved the final manuscript.
Supported by The Fatty Liver Research Fund, Faculty of Medicine Foundation, Chulalongkorn University.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, No. 238/59.
Informed consent statement: This is a retrospective study, and an exemption of a signed informed consent application was approved by the Ethics Committee. The analysis used anonymous clinical data after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement–a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sombat Treeprasertsuk, MD, PhD, Instructor, Professor, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, King Chulalongkorn Memorial Hospital 1873 Rama 4 Road, Pathumwan District, Bangkok 10330, Thailand. battan5410@gmail.com
Received: September 14, 2021
Peer-review started: September 14, 2021
First decision: November 16, 2021
Revised: November 25, 2021
Accepted: March 15, 2022
Article in press: March 15, 2022
Published online: April 21, 2022
Processing time: 212 Days and 16.5 Hours
BACKGROUND
Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease (NAFLD) management. The fibrosis-8 (FIB-8) score, recently developed by incorporating four additional variables into the fibrosis-4 (FIB-4) score, showed better performance in predicting significant fibrosis in NAFLD.
AIM
To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score (NFS) for predicting significant fibrosis.
METHODS
We collected the data of biopsy-proven NAFLD patients from three Asian centers in three countries. All the patients with available variables for the FIB-4 score (age, platelet count, and aspartate and alanine aminotransferase levels) and FIB-8 score (the FIB-4 variables plus 4 additional parameters: The body mass index (BMI), albumin to globulin ratio, gamma-glutamyl transferase level, and presence of diabetes mellitus) were included. The fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria, and significant fibrosis was defined as at least fibrosis stage 2.
RESULTS
A total of 511 patients with biopsy-proven NAFLD and complete data were included for validation. Of these 511 patients, 271 (53.0%) were female, with a median age of 51 (interquartile range: 41, 58) years. The median BMI was 29 (26.3, 32.6) kg/m2, and 268 (52.4%) had diabetes. Among the 511 NAFLD patients, 157 (30.7%) had significant fibrosis (≥ F2). The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774, 0.743, and 0.680, respectively. The FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS (P = 0.001) and was also clinically superior to FIB-4, although statistical significance was not reached (P = 0.073). The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36% sensitivity, and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.77 showed 67.51% specificity.
CONCLUSION
We demonstrated that the FIB-8 score had significantly better performance for predicting significant fibrosis in NAFLD patients than the NFS, as well as clinically superior performance vs the FIB-4 score in an Asian population. A novel simple fibrosis score comprising commonly accessible basic laboratories may be beneficial to use for an initial assessment in primary care units, excluding patients with significant liver fibrosis and aiding in patient selection for further hepatologist referral.
Core Tip: Noninvasive diagnosis of hepatic fibrosis is crucial for nonalcoholic fatty liver disease (NAFLD). The fibrosis-8 (FIB-8) score was recently developed by incorporating four additional variables into the fibrosis-4 (FIB-4) score. The diagnostic performance of the FIB-8 score exhibited higher accuracy in diagnosing significant fibrosis (≥ F2) than the NAFLD fibrosis score but was not superior to the FIB-4 score in our Asian cohort population. We postulated that gamma-glutamyl transferase might be an additional variable that predicts significant fibrosis in NAFLD patients.
