The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited.
Dr Petta and colleagues from Italy assessed the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients.
The team analyzed data from 741 patients with a histological diagnosis of NAFLD.
The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Scores were calculated according to published algorithms.
Liver stiffness measurement was performed by FibroScan.
|The serial combination generated an accuracy ranging to 70%|
|Alimentary Pharmacology & Therapeutics|
Liver stiffness measurement, NAFLD Fibrosis Score and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis, with Liver stiffness measurement having the highest sensitivity, and the highest negative predictive value, and NAFLD Fibrosis Score and FIB-4 the highest specificity, and the highest positive predictive value.
The paired combination of Liver stiffness measurement or NAFLD Fibrosis Score with FIB-4 strongly reduced the likelihood of wrongly classified patients, at the price of a high uncertainty area, and of a low overall accuracy.
The serial combination with the second test used in patients in the grey area of the first test and in those with high Liver stiffness measurement values or low NAFLD Fibrosis Score or FIB-4 values overall increased the diagnostic performance generating an accuracy ranging to 70%, an uncertainty area ranging from 19% to 20%, and a rate of wrong classification ranging from 9% to 11%.
Dr Petta's concludes, "The serial combination of Liver stiffness measurement with FIB-4/NAFLD Fibrosis Score has a good diagnostic accuracy for the non-invasive diagnosis of severe fibrosis in NAFLD."