USE OF THE FIB4 INDEX FOR NON-INVASIVE EVALUATION OF FIBROSIS IN NONALCOHOLIC FATTY LIVER DISEASE

By Amy G. Shah, A. Lydecker, K. Murray, Brent Tetri, M. Contos, A. Sanyal. Clinical Gastroenterology and Hepatology, 2009

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Background There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in nonalcoholic fatty liver disease (NAFLD). Aim To compare the performance of the FIB4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with six 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 seven 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 (IQR=0.74–1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% CI: 0.758, 0.847) which was higher than that for the NAFLD fibrosis score (0.768 CI:0.720–0.816, p= 0.09), Goteburg University Cirrhosis Index (0.743, CI:0.695–0.791, p< 0.01), AST:ALT ratio (0.742, CI:0.690–0.794, p< 0.015), AST to platelet ratio index (0.730, CI:0.681–0.779, p< 0.001), AST to platelet ratio (0.720, 0.669–0.770, p< 0.001), BARD score (0.70, p< 0.001) and cirrhosis discriminant score (0.666, CI:0.614–0.718, p< 0.001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity of identifying advanced fibrosis was only 50% (95% CI: 46, 55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≤ 1.30 had a 90% negative predictive value. Conclusions The FIB4 index is superior to seven other non-invasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better non-invasive markers.

Subfields: Epidemiology, Hepatology

View Paper: https://www.semanticscholar.org/paper/f6c0854b1e6a016de746ce031aa415c9d9424f72

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Citations in the corpus

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases (2019, background): “Among 14 serum-based biomarker panels for hepatic fibrosis, the FibroTest,(247-249) the serum AST/platelet ratio index (APRI),(250) the Fibrosis-4 index (FIB-4),(251,252) and the enhanced liver fibrosis test(253,254) have emerged as the better candidates in AIH.”
Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease (2017, methodology): “Similarly, the fibrosis stages in population based studies represent best estimates based on use of clinical aids such as the FIB4, APRI and NAFLD fibrosis scores (21, 42, 43).”
EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. (2016, neutral): “Shah, 2009 [45] FIB-4 index Age, ALT, AST, platelets 541 ≥2.”
Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years (2010, methodology): “FIB-4 was calculated as age3AST (U/l)/platelet count (310(9)/l)3OALT (U/l), where ALT is alanine aminotransferase.(23) The NAFLD fibrosis score was calculated according to the following formula: 1.”
EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. (2015, background): “In patients with NAFLD, the NAFLD fibrosis score [40] is currently the most studied [85,113–118] and validated biomarker [119].”