title: The utility of the "NAFLD fibrosis score" in morbidly obese subjects with NAFLD.
abstract: BACKGROUND
  To date, the noninvasive diagnostic tests for hepatic fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) have proven to be suboptimal. We evaluated the validity of a recently proposed "NAFLD fibrosis score" to identify liver fibrosis in morbidly obese individuals with elevated and normal alanine aminotransferase (ALT) levels.
  
  
  METHODS
  Medical records of 401 patients that underwent a gastric bypass operation and intraoperative liver biopsy were analyzed. Three hundred thirty one patients with biopsy-proven NAFLD were included in the study (group A). These patients were divided into two ALT groups based on their levels according to the new proposed normal range: group B elevated level (ALT > 19 U/L in females and >30 U/L in males, n = 221) and group C normal ALT (n = 110). Diagnostic accuracy of the system was assessed for the presence/absence of any fibrosis, significant fibrosis (stage 2-4), and advanced fibrosis (stages 3 and 4) in all of the groups.
  
  
  RESULTS
  The prevalence of advanced fibrosis in our cohort was about 14%. The low NAFLD fibrosis score demonstrated high accuracy for ruling out advanced fibrosis, with negative predictive value (NPV) of 98 and 99% in groups A and B, respectively. The NPV for significant fibrosis in groups A, B, and C was 87, 88, and 88%, respectively. The respective positive predictive value for the high NAFLD fibrosis score for the presence of any fibrosis was 88, 95, and 77% in groups A, B, and C.
  
  
  CONCLUSIONS
  The NAFLD fibrosis score may be a useful noninvasive approach for excluding significant and advanced fibrosis and in morbidly obese patients.
authors.affiliation: Department of Pathology, University of Alabama, Birmingham, AL, USA, kqureshi@uab.edu
authors.forename: Kamran
authors.initials: K
authors.lastname: Qureshi
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Clements
authors.forename: Gary A
authors.initials: GA
authors.lastname: Abrams
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001707:Biopsy, Needle; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D011237:Predictive Value of Tests
chemical_list: D000410:Alanine Transaminase