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Non-alcoholic fatty liver disease Noninvasive scores

Introduction

Noninvasive scores for predicting MAFLD
Components AUC Link
LiverRisk score[1] seven predictors: age, glucose, cholesterol, AST , ALT , GGT , platelet count 0.72[2] liverriskscore.com
(Proprietary)
NAFLD Fibrosis Score (NFS)[3] seven predictors: age, hyperglycemia, BMI, platelet count, albumin, and AST/ALT ratio 0.72 (at-risk population for F3)[4] MedCalc
NAFLD-MESA[5] eight predictors: age, sex, race/ethnicity, type 2 diabetes, smoking, BMI, GGT, and triglycerides 0.83 (general population for steatosis)[5]
NAFLD-Clinical Index[5]
(NAFLD-MESA with labs excluded) 		six predictors: age, sex, race/ethnicity, type 2 diabetes, smoking, BMI 0.78 (general population for steatosis)[5]
FIB-4 Index four predictors: age, AST, ALT, platelet count 0.913 (NAFLD population for for F3 and F4[6] MedCalc
University of Washington
MAF-5 (Metabolic Dysfunction-associated Fibrosis)[2] fix predictors: waist circumference, BMI, diabetes, AST, and platelet count 0.81 (at-risk population for F3)[2]
AST-platelet ratio index (APRI) two predictors: AST and platelet count 0.923 (NAFLD population for for F3 and F4[6] MedCalc

APRI (AST-platelet ratio index) at MedCalc uses two predictors: AST and platelet count using the equation 100 * ((AST/Top normal AST)/(Platelets/1000)).[7][6] Interpretation fo the APRI per UpToDate is[8]:

  • APRI ≤0.3: Unlikely cirrhosis or significant fibrosis
  • APRI >0.3 and ≤0.5: Unlikely cirrhosis, significant fibrosis possible
  • APRI >0.5 and ≤1.5: Significant fibrosis or cirrhosis possible
  • APRI >1.5 and ≤2: Likely significant fibrosis, cirrhosis possible
  • APRI >2: Likely cirrhosis


FIB-4 index at MedCalc and https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4 . For assessing need for biopsy in hepatitis B and hepatitis C.[4]

Metabolic Dysfunction-associated Fibrosis (MAF-5) has been compared to the FIB-4 for predicting fibrosis was defined as liver stiffness = 8.0 kPa.[2] The MAF-5 includes the factors: waist circumference, body mass index (calculated as kg / m2), diabetes, aspartate aminotransferase, and platelets. The MAF-5 had a higher area under the curve (AUC).

NAFLD fibrosis score uses Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio.MedCalc[3][4]

The NAFLD-MESA Index Clinical Index[5]

The NAFLD-MESA Index uses “eight predictors: age, sex, race/ethnicity, type 2 diabetes, smoking history, body mass index, gamma-glutamyltransferase (GGT), and triglycerides (TG)”[5] The score predicted NAFLD by liver computed tomography (≤ 40 Hounsfield units indicating > 30% hepatic steatosis) with AUC = 0.80.

The LiverRisk score *https://www.liverriskscore.com/) uses seven predictors (age, glucose, cholesterol, AST , ALT , GGT , platelet count) and may be more accurate than the FIB-4 or aspartate transferase to platelet ratio index (APRI) at predicting liver stiffness measurements with AUC 0.83 [95% CI [0·78–0·89]) versus the FIB-4 Index (95% CI 0.68 [0.61–0.75]. The score predicted 6 kPa or more, 10 kPa or more, and 15 kPa[1]. These kPa thresholds correspond to:

  • 6 kPa: no fibrosis
  • 10 kPa: between F3 and F4 fibrosis
  • 15 kPa: above F4 fibrosis

Fibrotic NASH Index (FNI) which contains the AST, HDL, HbA1c[9].

References

  1. ↑ 1.0 1.1 Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E; et al. (2023). “Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study”. Lancet. doi:10.1016/S0140-6736(23)01174-1. PMID 37572680 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 van Kleef LA, Francque SM, Prieto-Ortiz JE, Sonneveld MJ, Sanchez-Luque CB, Prieto-Ortiz RG; et al. (2024). “Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) Score Predicts Liver Fibrosis Risk and Outcome in the General Population With Metabolic Dysfunction”. Gastroenterology. doi:10.1053/j.gastro.2024.03.017. PMID 38513745 Check |pmid= value (help).
  3. ↑ 3.0 3.1 Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC; et al. (2007). “The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD”. Hepatology. 45 (4): 846–54. doi:10.1002/hep.21496. PMID 17393509.
  4. ↑ 4.0 4.1 4.2 4.3 Graupera I, Thiele M, Serra-Burriel M, Caballeria L, Roulot D, Wong GL; et al. (2022). “Low Accuracy of FIB-4 and NAFLD Fibrosis Scores for Screening for Liver Fibrosis in the Population”. Clin Gastroenterol Hepatol. 20 (11): 2567–2576.e6. doi:10.1016/j.cgh.2021.12.034. PMID 34971806 Check |pmid= value (help).
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Rodriguez LA, Shiboski SC, Bradshaw PT, Fernandez A, Herrington D, Ding J; et al. (2021). “Predicting Non-Alcoholic Fatty Liver Disease for Adults Using Practical Clinical Measures: Evidence from the Multi-ethnic Study of Atherosclerosis”. J Gen Intern Med. 36 (9): 2648–2655. doi:10.1007/s11606-020-06426-5. PMC 8390627 Check |pmc= value (help). PMID 33501527 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 Amernia B, Moosavy SH, Banookh F, Zoghi G (2021). “FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran”. BMC Gastroenterol. 21 (1): 453. doi:10.1186/s12876-021-02038-3. PMC 8642865 Check |pmc= value (help). PMID 34861841 Check |pmid= value (help).
  7. ↑ Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH; et al. (2011). “Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis”. Hepatology. 53 (3): 726–36. doi:10.1002/hep.24105. PMID 21319189.
  8. ↑ UpToDate. Calculator: Aspartate aminotransferase (AST) to platelet ratio index (APRI) in adults (conventional units). Available at https://www.uptodate.com/contents/calculator-aspartate-aminotransferase-ast-to-platelet-ratio-index-apri-in-adults-conventional-units
  9. ↑ Tavaglione F, Jamialahmadi O, De Vincentis A, Qadri S, Mowlaei ME, Mancina RM; et al. (2023). “Development and Validation of a Score for Fibrotic Nonalcoholic Steatohepatitis”. Clin Gastroenterol Hepatol. 21 (6): 1523–1532.e1. doi:10.1016/j.cgh.2022.03.044. PMID 35421583 Check |pmid= value (help).

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]