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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
ARTICLE HIGHLIGHTS
Research background
In the nonalcoholic fatty liver disease (NAFLD) population, noninvasive fibrosis scores, such as the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS), are generally applied in clinical practice guidelines. The novel fibrosis-8 (FIB-8) score yielded higher accuracy in diagnosing significant fibrosis in a previously reported cohort. A larger cohort may provide more reliability and benefit in clinical practice.
Research motivation
A noninvasive fibrosis score in NAFLD patients using only routine laboratory parameters is particularly important in initial assessment in the primary care unit or resource-limited conditions. We proposed the novel FIB-8 score, which incorporates the additional variables body mass index (BMI), the A/G ratio, gamma-glutamyl transferase (GGT), and diabetes into the FIB-4 score. The additional variables, particularly GGT, may provide better diagnostic accuracy for predicting significant fibrosis in NAFLD patients.
Research objectives
We aimed to validate the FIB-8 score among patients with a biopsy-proven NAFLD cohort and to compare the diagnostic performance of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis.
Research methods
This was a retrospective study involving 1013 biopsy-proven NAFLD patients from 3 Asian centers in 3 countries in an Asian population. All the patients with available baseline biochemical tests for the FIB-8 score calculation and all related variables for predicting liver fibrosis were included.
Research results
A total of 1013 patients were included in the final analysis. Of those, 511 patients had complete data on the variables, including the NFS and FIB-4 and FIB-8 scores. One hundred fifty-seven (30.7%) patients 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 had significantly better performance for predicting significant fibrosis than the NFS (P = 0.001) but was not superior to the FIB-4 score (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 had 67.51% specificity.
Research conclusions
The FIB-8 score, which incorporates the additional variables of the BMI, A/G ratio, GGT level, and diabetes into the FIB-4 score, yielded better performance for predicting significant fibrosis in NAFLD patients than the NFS but was not superior to the FIB-4 score in the Asian population. A simple fibrosis score comprising commonly accessible basic laboratories may be used for an initial assessment in primary care units.
Research perspectives
Future prospective studies are needed to compare the diagnostic accuracy of various noninvasive scores for predicting significant fibrosis and staging fibrosis.
