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Suboptimal performance of simple noninvasive tests for advanced fibrosis in C hinese patients with nonalcoholic fatty liver disease
Author(s) -
Xun Yun Hao,
Fan Jian Gao,
Zang Guo Qing,
Liu Hong,
Jiang Yan Ming,
Xiang Jing,
Huang Qian,
Shi Jun Ping
Publication year - 2012
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/j.1751-2980.2012.00631.x
Subject(s) - medicine , nonalcoholic fatty liver disease , gastroenterology , fibrosis , aspartate transaminase , receiver operating characteristic , liver biopsy , alanine transaminase , body mass index , stage (stratigraphy) , biopsy , transaminase , fatty liver , predictive value of tests , steatohepatitis , disease , alkaline phosphatase , paleontology , biochemistry , chemistry , biology , enzyme
Objective To evaluate the diagnostic accuracy of some noninvasive fibrosis models in Chinese patients with nonalcoholic fatty liver disease ( NAFLD ). Methods Consecutive biopsy‐proven NAFLD patients were recruited from a single center from J anuary 2005 to D ecember 2010. Advanced fibrosis (stage 3 and 4) was defined using Kleiner criteria. The area under the receiver operating characteristic curve ( AUROC ) was used to compare the diagnostic accuracy of the NAFLD fibrosis score ( NFS ), FIB ‐4 index, aspartate transaminase ( AST) /platelet ratio index ( APRI ), AST /alanine transaminase ( ALT) ratio ( AAR ) and body mass index ( BMI )‐ AAR ‐Diabetes ( BARD ) score. Results Of the patients with NAFLD , 79.6% were males with a mean age of 37.1 years, mean BMI of 26.1 kg/m 2 and 41.4% of them had nonalcoholic steatohepatitis, and 24 (15.8%) had advanced fibrosis. The AUROC of the FIB ‐4 index, APRI , AAR , NFS and BARD score for advanced fibrosis were 0.756, 0.742, 0.670, 0.653 and 0.642 ( P < 0.05 for all), respectively. A concordant negative predictive value of approximately 90% was indicated whereas the positive predictive values were modest for all tests, and only the FIB ‐4 index yielded a higher positive likelihood ratio of 7.65. Using these cut‐off values of tests for excluding advanced fibrosis could reduce the use of liver biopsy in 56.6–74.3% of the patients, with a minor false negative rate of 5.3–9.9%. Conclusions Although slightly less accurate than liver biopsy, simple noninvasive tests can reliably exclude advanced fibrosis in Chinese NAFLD patients in our center. FIB ‐4 index performs better than the other tests under examination.