Prospective Comparison of Noninvasive Fibrosis Assessment to Predict Advanced Fibrosis or Cirrhosis in Non-alcoholic Fatty Liver Disease

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease. Its prevalence continues to rise, and it threatens to become a serious health problem. This study aimed to evaluate the diagnostic accuracy of noninvasive fibrosis assessment in predicting advanced fibrosis or cirrhosis in patients with NAFLD. Methods: One hundred sixteen patients with a liver biopsy-confirmed diagnosis of NAFLD were prospectively evaluated between March 2013 and September 2014. Liver stiffness measurement (LSM) was performed by acoustic radiation force impulse (ARFI) elastography in all patients. Aspartate aminotransferase to alanine aminotransferase ratio (AAR), FIB-4 index, aspartate aminotransferase to platelet ratio index (APRI), NAFLD fibrosis score (NFS) and BARD score were calculated according to published algorithms. In order to predict advanced fibrosis or cirrhosis, diagnostic measurements of serum fibrosis indices and ARFI imaging were compared by analyzing the area under the receiver operating characteristic (AUROC) curve. Results: The median age of the study population was 54.3 years (range, 18–78). The FIB-4 index, NAFLD fibrosis score, BARD score and LSM showed significant, positive correlations with the METAVIR stages (P<0.001). The LSM by ARFI had the greatest AUROC for predicting advanced fibrosis (≥F3) (0.883

95% CI, 0.804–0.961) and cirrhosis (F4) (0.926

95% CI, 0.848–1.000). The FIB-4 index had the good AUROC for predicting cirrhosis (F4) (0.873

95% CI, 0.803–0.942). Conclusions: LSM by ARFI was a useful noninvasive assessment for predicting advanced fibrosis and cirrhosis in patients with NAFLD. In addition, the FIB-4 index exhibited acceptable diagnostic performance in the assessment of hepatic fibrosis in patients with NAFLD.