Patients with nonalcoholic fatty liver disease and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease.
Dr Paul Andulo and colleagues from Minnesota constructed and validated a scoring system to separate nonalcoholic fatty liver disease patients with and without advanced fibrosis.
The scoring system consisted of routinely measured and readily available clinical and laboratory data.
|The negative predictive value was 93% in Group 1|
The team assessed a total of 733 patients with nonalcoholic fatty liver disease confirmed by liver biopsy.
The patients were divided into 2 groups.
The team constructed a scoring system with 480 patients in Group 1.
The other 253 patients were divided into Group 2 to validate the scoring system.
Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling.
The researchers used these variables to predict presence or absence of advanced fibrosis.
The team found that age, hyperglycemia, and body mass index were independent indicators of advanced liver fibrosis.
Platelet count, albumin, and AST/alanine transferase ratio were also independent indicators of advanced liver fibrosis.
A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.9 and 0.8 in Groups 1 and 2, respectively.
The researchers found by applying the low cutoff score, advanced fibrosis could be excluded with high accuracy.
The team noted that the negative predictive value was 93% and 88% in Groups 1 and 2, respectively.
By applying the high cutoff score, the team diagnosed the presence of advanced fibrosis with high accuracy.
The researchers found that the positive predictive values in Groups 1 and 2 were 90% and 82%, respectively.
By applying this model, the team noted that a liver biopsy would have been avoided in 75% of patients.
The researchers observed that by applying the model, a correct prediction would have occurred in 90%.
Dr Andulo's team concluded, "A simple scoring system accurately separates patients with nonalcoholic fatty liver disease with and without advanced fibrosis."
"This renders liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients."