Nonalcoholic fatty liver disease is common and many affected individuals have normal-range alanine aminotransferase levels.
Dr Stuart Mc Pherson and colleagues reported that there is a need for a robust screening tool to triage individuals with advanced fibrosis for specialist care.
The research team assessed the performance of noninvasive fibrosis tests in patients with biopsy-proven nonalcoholic fatty liver disease, and normal levels of alanine aminotransferase.
The research team assessed that patients presenting at a fatty liver clinic between 1999 and 2009 were included in the study.
Liver biopsies were assessed using the Kleiner score.
The team of doctors noted that the aspartate aminotransferase alanine aminotransferase/alanine aminotransferase ratio, BARD, FIB-4 and Nonalcoholic fatty liver disease fibrosis scores were calculated.
A total of 305 patients were included.
|61% with normal alanine aminotransferase levels could avoid liver biopsy |
|European Journal of Gastroenterology & Hepatology|
The researchers examined that in total, 24% of patients with normal alanine aminotransferase levels, and 17% of those with elevated alanine aminotransferase levels had advanced fibrosis.
The FIB-4 performed best in identifying advanced fibrosis in patients with normal alanine aminotransferase.
The doctors noted that the sensitivity of the AST/alanine aminotransferase ratio and BARD and nonalcoholic fatty liver disease fibrosis scores for advanced fibrosis was good in patients with normal ALT levels, but the specificity was low.
The FIB-4 yielded best results in patients with elevated alanine aminotransferase levels.
Using the FIB-4, 61% of patients with normal alanine aminotransferase levels, and 63% of those with elevated alanine aminotransferase levels could avoid liver biopsy to exclude advanced fibrosis.
In contrast, AST/alanine aminotransferase ratio and BARD and nonalcoholic fatty liver disease scores would have led to a high proportion of patients with mild disease having to undergo a biopsy.
Dr McPherson's team commented, "The FIB-4 yielded good results in patients with normal or elevated alanine aminotransferase levels, reliably excluding advanced fibrosis and reducing the need for liver biopsy."