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
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.
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.
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.
Consecutive patients with histologically-confirmed MAFLD admitted to a single medical center 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. 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.
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.
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.