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Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.

Publication ,  Journal Article
Shah, AG; Lydecker, A; Murray, K; Tetri, BN; Contos, MJ; Sanyal, AJ; Nash Clinical Research Network
Published in: Clin Gastroenterol Hepatol
October 2009

BACKGROUND & AIMS: There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD. METHODS: Using a nation-wide database of 541 adults with NAFLD, jackknife-validated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. RESULTS: The median FIB4 score was 1.11 (interquartile range = 0.74-1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% confidence interval [CI], 0.758-0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95% CI, 0.720-0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95% CI, 0.695-0.791; P < .01), AST:ALT ratio (0.742; 95% CI, 0.690-0.794; P < .015), AST:platelet ratio index (0.730; 95% CI, 0.681-0.779; P < .001), AST:platelet ratio (0.720; 95% CI, 0.669-0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95% CI, 0.614-0.718; P < .001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50% (95% CI, 46-55). A FIB4 > or = 2.67 had an 80% positive predictive value and a FIB4 index < or = 1.30 had a 90% negative predictive value. CONCLUSIONS: The FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.

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Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

October 2009

Volume

7

Issue

10

Start / End Page

1104 / 1112

Location

United States

Related Subject Headings

  • ROC Curve
  • Predictive Value of Tests
  • Platelet Count
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Fatty Liver
 

Citation

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Shah, A. G., Lydecker, A., Murray, K., Tetri, B. N., Contos, M. J., Sanyal, A. J., & Nash Clinical Research Network. (2009). Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 7(10), 1104–1112. https://doi.org/10.1016/j.cgh.2009.05.033
Shah, Amy G., Alison Lydecker, Karen Murray, Brent N. Tetri, Melissa J. Contos, Arun J. Sanyal, and Nash Clinical Research Network. “Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol 7, no. 10 (October 2009): 1104–12. https://doi.org/10.1016/j.cgh.2009.05.033.
Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009 Oct;7(10):1104–12.
Shah, Amy G., et al. “Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol, vol. 7, no. 10, Oct. 2009, pp. 1104–12. Pubmed, doi:10.1016/j.cgh.2009.05.033.
Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, Nash Clinical Research Network. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009 Oct;7(10):1104–1112.
Journal cover image

Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

October 2009

Volume

7

Issue

10

Start / End Page

1104 / 1112

Location

United States

Related Subject Headings

  • ROC Curve
  • Predictive Value of Tests
  • Platelet Count
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Fatty Liver