Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease

Figure 1 Fagan′s nomogram for (A) transient elastography and (B) magnetic resonance elastography studies.

Figure 2 Fagan′s nomogram for all diagnostic methods. ARFI: Acoustic radiation force impulse; FIB-4: Fibrosis-4 index; NFS: Non-alcoholic fatty liver disease fibrosis score; APRI: Aspartate aminotransferase to platelet ratio index; MRE: Magnetic resonance elastography; TE: Transient elastography; HFS: Hepamet fibrosis score.

Figure 3 Diagnostic flow-chart to assess liver fibrosis in patients with non-alcoholic fatty liver disease. NAFLD: Non-alcoholic fatty liver disease; T2DM: Type 2 diabetes mellitus; IR: Insulin resistance; OSA: Obstructive sleep apnoea; DLP: Dyslipidemia; HFS: Hepamet fibrosis score; NFS: Non-alcoholic fatty liver disease fibrosis score; FIB-4: Fibrosis-4 index; APRI: Aspartate aminotransferase to platelet ratio index; AF: Advanced fibrosis; TE: Transient elastography; MRE: Magnetic resonance elastography; BMI: Body mass index; ALT: Alanine aminotransferase.

Figure 4 Management flow-chart for patients with non-alcoholic fatty liver disease advanced fibrosis. We suggest vitamin E as it has demonstrated higher transplant-free survival and lower rates of hepatic decompensation. ¹Other drugs such as cenicriviroc, obethicholic acid, dapagliflozin, and selonsertib have shown benefit in clinical trials and must be considered as well, especially as results continue to show beneficial results. NAFLD: Non-alcoholic fatty liver disease; RAS: Renin-angiotensin system; T2DM: Type 2 diabetes mellitus; CPAP: Continuous positive airway pressure; BW: Body weight.