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

Table 1 Diagnostic performance of blood tests and scores for fibrosis assessment methods from studies made in patients with non-alcoholic fatty liver disease

	Population (n)	Ref.	Cutoffs	Se	Sp	PPV	NPV	AUROC
FIB-4 (age, platelet count, AST and ALT)	541	[52]	≤ 1.3 NF	74%	71%	43%	90%	0.802
			≥ 2.67 AF	33%	98%	80%	83%
	153	[53]	≥ 1.3 AF	87%	60%	NA	NA	0.895
	452	[56]	≥ 1.5 AF	75%	67%	58%	82%	0.780
	328	[57]	≤ 1.3 NF	56%	56%	22%	85%	0.540
			≥ 2.67 AF	22%	87%	27%	84%
APRI (AST and platelet count)	153	[53]	> 1 AF	78%	82%	NA	NA	0.830
			> 2 AF	28%	92%	NA	NA
	452	[56]	> 0.559 AF	62%	76%	61%	76%	0.754
NFS (age, glycaemia, BMI, platelet count, albumin, AST and ALT)	480	[55]	≤ -1.455 NAF	82%	77%	56%	93%	0.820
			≥ 0.676 AF	51%	98%	90%	85%
	126	[58]	≤ -1.455 NAF; ≥ 0.676 AF	96%	84%	70%	98%	0.919
	138	[59]	≤ -1.455 NAF	22%	100%	100%	81%	0.680
			≥ 0.676 AF
	452	[56]	> -1.036 AF	77%	60%	54%	81%	0.732
	328	[57]	≤ -1.455 NAF	53%	67%	26%	87%	0.640
	122	[61]	≥ 0.676 AF	9%	98%	50%	83%	0.840
				NA	NA	59%	89%
BARD (BMI > 28 kg/m2, AST/ALT ratio > 0.8 and diabetes)	126	[58]	0-1 NAF	89%	89%	69%	97%	0.919
			2-4 AF
	138	[59]	0-1 NAF	51%	77%	45%	81%	0.670
			2-4 AF
	160	[60]	0-1 NAF	NA	NA	27%	97%	0.780
			2-4 AF
	452	[56]	2-4 AF	79%	51%	50%	80%	0.695
	122	[61]	2-4 AF	NA	NA	59%	77%	0.730
	328	[57]	2-4 AF	83%	37%	22%	91%	0.594
Fibrometer NAFLD	452	[56]	≥ 0.311 AF	80%	62%	56%	83%	0.817
Hepascore (age, sex, bilirubin, GGT, hyaluronic acid, and a2-macroglobulin)	452	[56]	≥ 0.322 AF	67%	76%	63%	79%	0.778
Fibrotest (α-2-macroglobulin, haptoglobin, apolipoprotein A1, GGT, and TB)	452	[56]	≥ 0.316 AF	81%	57%	54%	83%	0.736
HFS (sex, age, HOMA score, diabetes, AST, albumin, and platelets)	2452	[69]	< 0.12 NAF	73.9%	77.4%	46%	91.9%	0.848
			≥ 0.47 AF	35.2%	97.2%	76.3%	85.2%
	49	[70]	≥ 0.47 AF	11%	100%	100%	83%	NA

Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; AUROC: Area under the curve; FIB-4: Fibrosis-4 index; APRI: Aspartate aminotransferase to platelet ratio index; NFS: Non-alcoholic fatty liver disease fibrosis score; HFS: Hepamet fibrosis score; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; BMI: Body mass index; GGT: Gamma-Glutamyltransferase; TB: Total bilirubin; HOMA: Homeostatic model assessment; NF: No fibrosis; AF: Advanced fibrosis; NAF: Non-advanced fibrosis; NA: Not available.

Table 2 Diagnostic performance of imaging studies for fibrosis assessment methods from studies made in patients with non-alcoholic fatty liver disease

	Population	Ref.	Cutoffs	Se	Sp	PPV	NPV	AUROC
TE [LSM (kPA)]	n = 291	[85]	≥ 8.2 kPa AF	90%	61%	NA	NA	0.870
			≥ 12.5 kPa AF	57%	90%	NA	NA	NA
	452	[56]	≥ 8.7 kPa AF	88%	63%	59%	90%	0.831
	142	[77]	≥ 11.7 kPa AF	86%	84%	75%	92%	0.880
	79	[83]	≥ 9.5 kPa AF	92%	63%	54%	94%	NA
MRE [LSM (kPA)]	142	[77]	≥ 4.8 kPa AF	74%	87%	74%	81%	0.890
	628	[63]	≥ 3.6 kPa AF	86%	91%	71%	93%	NA
	117	[97]	≥ 3.63 kPa AF	81%	89%	68%	97%	NA
	142	[98]	≥ 4.15 kPa AF	85%	92%	NA	NA	0.954
	102	[99]	> 3.64 kPa AF	92%	90%	NA	NA	0.957
ARFI [SWV (m/s)]	291	[85]	≥ 1.15 AF	90%	63%	NA	NA	0.840
			≥ 1.53 AF	59%	90%	NA	NA	NA
	57	[90]	≥ 1.45 AF	76%	68%	NA	NA	0.910
	32	[91]	≥ 1.3 AF	85%	83%	NA	NA	NA
	23		≥ 1.47 AF	100%	75%	NA	NA	0.942
	NASH	[92]
	54	[93]	≥ 1.77 AF	100%	91%	NA	NA	0.930

Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; AUROC: Area under the curve; TE: Transient elastography; MRE: Magnetic resonance elastography; ARFI: Acoustic radiation force impulse; LSM: Liver stiffness measurement; kPa: Kilopascal; SWV: Shear wave velocity; NASH: Non-alcoholic steatohepatitis; NF: No fibrosis; AF: Advanced fibrosis; NAF: Non-advanced fibrosis; NA: Not available.