DOI: 10.4103/jrms.jrms_1084_25 ISSN: 1735-1995

Evaluation of Fibrosis-4 Index, nonalcoholic fatty liver disease fibrosis score, and aspartate aminotransferase-to-platelet ratio index as noninvasive indicators of fibrosis in patients with nonalcoholic fatty liver disease

Mingxi Chen, Chang Guo, Ke Ouyang, Na Liu
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Background:

Multiple noninvasive scoring models have been internationally established and verified for assessing the risk of liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients. This study aimed to assess the performance of Fibrosis-4 (FIB-4) Index, NAFLD fibrosis score (NFS), and aspartate aminotransferase-to-platelet ratio index (APRI) in individuals with NAFLD.

Materials and Methods:

We conducted a retrospective chart audit of 211 patients with histologically confirmed NAFLD, focusing on clinical presentation, laboratory parameters, and hepatic histology. Liver fibrosis was graded using the Scheuer classification system. The diagnostic accuracy of the noninvasive tests was evaluated, and revised fibrosis score thresholds. These cohort-derived thresholds may help inform local risk stratification in patients with NAFLD, but external validation is required before clinical use.

Results:

Among the cohort, fibrosis was staged as follows: 5.7% showed no fibrosis (F0), 56.9% had mild portal expansion (F1), 21.8% exhibited periportal septa (F2), 10.9% displayed architectural distortion without cirrhosis (F3), and 4.7% presented with definite cirrhosis (F4). After threshold optimization, the FIB-4 and NFS models reached the area under the receiver operating characteristic curve (AUROCs) of 0.81 (95% confidence interval [CI]: 0.743–0.867) and 0.79 (95% CI: 0.728–0.852) for identifying significant fibrosis, surpassing the 0.70 (95% CI: 0.629–0.773) recorded for APRI. Significant differences in the AUROCs were observed among the three scores. Similarly, for advanced fibrosis, FIB-4 (AUROC: 0.91, 95% CI: 0.869–0.951) and NFS (AUROC: 0.90, 95% CI: 0.851–0.948) significantly outperformed APRI (AUROC: 0.75, 95% CI: 0.672–0.837; both P < 0.05). However, the AUROCs of the three scores were not significantly different in cirrhosis. For fibrosis exclusion, the optimal cutoffs we derived from FIB-4, NFS, and APRI were all lower than the conventional cutoffs while maintaining similar diagnostic accuracy.

Conclusion:

Modification of the threshold values for FIB-4, NFS, and APRI may enhance the diagnostic performance in patients with NAFLD.

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