COMPARISON OF SEROLOGICAL MODELS OF LIVER FIBROSIS AGAINST TRANSIENT ELASTOGRAPHY BY FIBROSCAN® IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Introduction and Objectives

Liver fibrosis is the most important prognostic factor in nonalcoholic fatty liver disease (NAFLD). The study's objective is to compare the serological models of liver fibrosis (NAFLD-FS, FIB-4, BARD, APRI and AST/ALT) against transient elastography by FibroScan® in patients with NAFLD.

Materials and Methods

Observational, retrolective and cross-sectional study of records of patients diagnosed with liver steatosis by FibroScan® without significant alcohol consumption. A Pearson's correlation and heat maps were used for the correlation between results of FibroScan® and the serological models of liver fibrosis. ROC curves were analyzed to compare the serological models against FibroScan® as the gold standard for clinically significant liver fibrosis.

Results

Data from 976 files were collected, with a prevalence of 63% of liver steatosis by FibroScan® (CAP >232 dB/min) and 1.74% of significant liver fibrosis (LSM >7.0 kPa). In patients with NAFLD, a low positive correlation of NAFLD-FS (r=0.291; p<0.001) and BARD (r=0.021; p<0.001) and a very low positive correlation of APRI (r=0.184; p<0.001) with clinically significant liver fibrosis was reported. No correlation was observed with FIB-4 (r=-0.003; p=0.943) or with the AST/ALT ratio (r=-0.039; p=0.336). The NAFLD-FS reported an area under the curve (AUC) of 0.838 (95%CI 0.76-0.91) and the APRI of 0.797 (95%CI 0.68-0.92) compared to FibroScan® for clinically significant liver fibrosis (Figure 1).

Discussion

Liver biopsy is an invasive method and the gold standard for evaluating liver fibrosis; however, it is not exempt of complications. Transient elastography by FibroScan® is a non-invasive and validated method but with limited availability and accessibility. Serological models are widely available and can be easily used in daily practice. In a previous study, the NAFLD-FS reported an AUC of 0.72 (95% CI 0.60-0.83) compared against liver biopsy, which is comparable to the AUC reported in this study against FibroScan®.

Conclusions

The NAFLD-FS is the serological model for liver fibrosis with the best AUC and correlation with transient elastography in patients with NAFLD and is proposed as an evaluation method in places where FibroScan® or liver biopsy is not available.

The authors declare that there is no conflict of interest.