Diagnostic accuracy of noninvasive steatosis biomarkers with magnetic resonance imaging proton density fat fraction as gold standard

Table 4 The diagnostic accuracy of noninvasive steatosis biomarkers in excluding or confirming the presence of nonalcoholic fatty liver disease as defined by magnetic resonance imaging proton density fat fraction ≥ 5%

Biomarkers	AUC (95%CI)	SE, %	SP, %	PLR	NLR	PPV, %	NPV, %	Accuracy, %	Overall accuracy to exclude1 and confirm2 NAFLD, %
FLI (n = 131)
Exclusionary cut-off < 20	0.766 (0.684-0.836)	99.0	54.3	2.16	0.02	85.6	95.0	87.0
Confirmatory cut-off ≥ 68	0.701 (0.614-0.777)	45.8	94.3	8.02	0.57	95.7	38.8	58.8	48.1
HSI (n = 131)
Exclusionary cut-off < 33	0.781 (0.700-0.848)	99.0	57.1	2.31	0.02	86.4	95.2	87.8
Confirmatory cut-off ≥ 39	0.790 (0.711-0.857)	66.7	91.4	7.78	0.36	95.5	50.0	73.3	64.1
ZJU index (n = 131)
Exclusionary cut-off < 34	0.766 (0.684-0.836)	99.0	54.3	2.16	0.02	85.6	95.0	87.0
Confirmatory cut-off ≥ 41	0.732 (0.647-0.805)	52.1	94.3	9.11	0.51	96.2	41.8	63.3	52.7
FSI (n = 131)
Exclusionary cut-off < 7	0.775 (0.694-0.844)	97.9	57.1	2.28	0.04	86.2	90.9	87.0
Confirmatory cut-off ≥ 42	0.711 (0.625-0.787)	47.9	94.3	8.39	0.55	95.8	39.8	60.3	50.4
TyG index (n = 131)
Exclusionary cut-off < 8.0	0.700 (0.614-0.777)	100.0	40.0	1.67	0.00	82.1	100.0	84.0
Confirmatory cut-off ≥ 9.2	0.664 (0.576-0.744)	38.5	94.3	6.74	0.65	94.9	35.9	53.4	38.9
VAI (n = 131)
Exclusionary cut-off < 0.79	0.638 (0.549-0.720)	99.0	28.6	1.39	0.04	79.2	90.9	80.2
Confirmatory cut-off ≥ 3.29	0.617 (0.528-0.701)	29.2	94.3	5.10	0.75	93.3	32.7	46.6	29.0

¹Criteria for the exclusionary cut-off were sensitivity > 90% and negative likelihood ratio ≤ 0.1.

²Criteria for the confirmatory cut-off were specificity > 90% and positive likelihood ratio ≥ 10.

AUC: Area under the receiver operating characteristic curve; 95%CI: 95% confidence interval; FLI: Fatty liver index; HSI: Hepatic steatosis index; FSI: Framingham steatosis index; TyG: Triglycerides and glucose; VAI: Visceral adiposity index; SE: Sensitivity; SP: Specificity; PLR: Positive likelihood ratio; NLR: Negative likelihood ratio; PPV: Positive predictive value; NPV: Negative predictive value; NAFLD: Nonalcoholic fatty liver disease.