Browse by author
Lookup NU author(s): Dr Stuart McPhersonORCiD,
Professor Alastair BurtORCiD,
Professor Chris Day
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
Background Accurate evaluation of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is important to identify patients who may develop complications. The aim of this study was to compare the diagnostic performance of simple non-invasive tests in identifying advanced fibrosis among patients with biopsy-proven NAFLD. Methods Consecutive patients with biopsy proven NAFLD were recruited from the Newcastle Hospitals Fatty Liver Clinic from 2003 to 2009. The AST/ALT ratio, AST to platelet ratio index, BARD (weighted sum of BMI>28=1 point, AST/ALT ratio>0.8=2 points, diabetes 1 point), FIB-4 (agexAST (IU/l)/platelet count (x10(9)/litre)x root ALT (IU/l)) and NAFLD fibrosis scores were calculated from blood tests taken at time of biopsy. Results 145 patients (82 male (61%), mean age 51612 years) were included. The mean body mass index was 35 +/- 5 kg/m(2). 73 subjects (50%) had diabetes. 93 patients (64%) had non-alcoholic steatohepatitis. 27 (19%) had advanced fibrosis (Kleiner stage 3-4). The FIB-4 score had the best diagnostic accuracy for advanced fibrosis (area under receiver operator characteristic curve (AUROC) 0.86), followed by AST/ALT ratio (AUROC 0.83), NAFLD fibrosis score (AUROC 0.81), BARD (AUROC 0.77) and AST to platelet ratio index (AUROC 0.67). The AST/ALT ratio, BARD score, FIB-4 and NAFLD fibrosis scores had negative predictive values greater than 90% (93%, 95%, 95% and 92% respectively). Positive predictive values were modest. In order to exclude advanced fibrosis liver biopsy could potentially be avoided in 69% with AST/ALT ratio, 62% with FIB-4, 52% with NAFLD fibrosis score and 38% with BARD. Conclusions The ALT/AST ratio, FIB-4 and NAFLD fibrosis scores can reliably exclude advanced fibrosis in a high proportion of patients with NAFLD, allowing liver biopsy to be used in a more directed manner.
Author(s): McPherson S, Stewart SF, Henderson E, Burt AD, Day CP
Publication type: Article
Publication status: Published
Print publication date: 01/09/2010
ISSN (print): 0017-5749
ISSN (electronic): 1468-3288
Publisher: BMJ Group
Altmetrics provided by Altmetric