title: The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD.
abstract: Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%).
  
  
  CONCLUSIONS
  a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. angulohernandez.paul@mayo.edu
authors: Paul
authors: P
authors: Angulo
authors: Jason M
authors: JM
authors: Hui
authors: Giulio
authors: G
authors: Marchesini
authors: Ellisabetta
authors: E
authors: Bugianesi
authors: Jacob
authors: J
authors: George
authors: Geoffrey C
authors: GC
authors: Farrell
authors: Felicity
authors: F
authors: Enders
authors: Sushma
authors: S
authors: Saksena
authors: Alastair D
authors: AD
authors: Burt
authors: John P
authors: JP
authors: Bida
authors: Keith
authors: K
authors: Lindor
authors: Schuyler O
authors: SO
authors: Sanderson
authors: Marco
authors: M
authors: Lenzi
authors: Leon A
authors: LA
authors: Adams
authors: James
authors: J
authors: Kench
authors: Terry M
authors: TM
authors: Therneau
authors: Christopher P
authors: CP
authors: Day
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D015995:Prevalence