title: Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease.
abstract: BACKGROUND
  Clinical predictors of advanced non-alcoholic liver disease (NAFLD) are needed to guide diagnostic evaluation and treatment.
  
  
  METHODS
  To better understand the demographics of NAFLD and risk factors for advanced disease, this study analysed 827 patients with NAFLD at two geographically separate tertiary medical centres.
  
  
  RESULTS
  The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m(2); 3% had a normal BMI. Common co-morbidities included hypertension (60%) and diabetes (35%); insulin resistance was present in 91% and advanced fibrosis in 24% of patients. When comparing patients with no fibrosis or mild fibrosis to those with advanced fibrosis, BMI > or = 28 kg/m(2), age > 50 years, and aspartate transaminase/alanine aminotransferase (AST/ALT) ratio > or = 0.8, a quantitative assessment check index (QUICKI) score < 0.294 (equivalent to homeostasis model assessment (HOMA) > 6.2) and the presence of diabetes mellitus (DM) were individually associated by univariate analysis with odds ratios (ORs) of > or = 2.4 for advanced fibrosis. Based on the results of forced entry logistic regression analysis, three variables were combined in a weighted sum (BMI > or = 28 = 1 point, AAR of > or = 0.8 = 2 points, DM = 1 point) to form an easily calculated composite score for predicting advanced fibrosis called the BARD score. A score of 2-4 was associated with an OR for advanced fibrosis of 17 (confidence interval 9.2 to 31.9) and a negative predictive value of 96%.
  
  
  CONCLUSIONS
  Insulin resistance and its co-morbidities are often present in patients with NAFLD. An easily calculated score based on readily available clinical data can reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.
authors.affiliation: Division of Gastroenterology and Hepatology, Brooke Army Medical Center, San Antonio, USA. Stephen.Harrison@amedd.army.mil
authors.forename: S A
authors.initials: SA
authors.lastname: Harrison
authors.forename: D
authors.initials: D
authors.lastname: Oliver
authors.forename: H L
authors.initials: HL
authors.lastname: Arnold
authors.forename: S
authors.initials: S
authors.lastname: Gogia
authors.forename: B A
authors.initials: BA
authors.lastname: Neuschwander-Tetri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005234:Fatty Liver / Q000209:etiology / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D008923:Missouri; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas