Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2021; 27(34): 5753-5763
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5753
Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease
Yin-Lian Wu, Rahul Kumar, Ming-Fang Wang, Medha Singh, Jiao-Feng Huang, Yue-Yong Zhu, Su Lin
Yin-Lian Wu, Ming-Fang Wang, Jiao-Feng Huang, Yue-Yong Zhu, Su Lin, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Rahul Kumar, Department of Gastroenterology and Hepatology, Duke-NUS academic Medical Centre, Changi General Hospital, Singapore 529889, Singapore
Medha Singh, Department of General Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Wu YL, Kumar R and Lin S designed the study; Wang MF and Singh M analyzed the data; Huang JF collected the data; Wu YL and Kumar R wrote the paper; Zhu YY and Lin S supervised the study; Wu YL and Kumar R contributed equally to this work; All authors contributed to the manuscript for important intellectual content and approved the submission.
Supported by Chinese National 13th Five-Year Plan’s Science and Technology Projects, No. 2017ZX10202201.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Fujian Medical University and was in accordance with the Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: Data are available on request.
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:
Corresponding author: Su Lin, MD, PhD, Associate Chief Physician, Professor, Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China.
Received: January 6, 2021
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
Research background

Metabolic associated fatty liver disease (MAFLD) is a new concept proposed in 2020. The clinical features of MAFLD would be different from nonalcoholic fatty liver disease.

Research motivation

Non-invasive fibrosis scores have been tested in subjects with nonalcoholic fatty liver disease showing great diagnostic accuracy in predicting fibrosis. But the utility of non-invasive fibrosis scores, as well as their optimal thresholds, needs re-evaluation in MAFLD.

Research objectives

This study aimed 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, and diabetes score (BARD), and nonalcoholic fatty liver disease fibrosis score (NFS) in patients with MAFLD.

Research methods

Consecutive patients with histologically-confirmed MAFLD admitted to a single medical center were included. The discrimination ability of different non-invasive scores was compared.

Research results

A total of 417 patients were included; 156 (37.4%) of them had advanced fibrosis. The area under receiver operating characteristic curve of FIB-4, NFS, APRI, and BARD for predicting advanced fibrosis were 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, respectively. A subgroup analysis showed that FIB-4, APRI, and NFS performed worse in the pure MAFLD group than the HBV-MAFLD group.

Research conclusions

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.

Research perspectives

MAFLD is a new entity. The results of this study indicate the conventional scores may lead to misdiagnosis, and the development of novel scoring systems to assess fibrosis in the MAFLD population is urgently needed.