title: Suboptimal performance of simple noninvasive tests for advanced fibrosis in Chinese patients with nonalcoholic fatty liver disease.
abstract: 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 January 2005 to December 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.
authors.affiliation: Department of Infective Disease, Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yun Hao
authors.initials: YH
authors.lastname: Xun
authors.forename: Jian Gao
authors.initials: JG
authors.lastname: Fan
authors.forename: Guo Qing
authors.initials: GQ
authors.lastname: Zang
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.forename: Yan Ming
authors.initials: YM
authors.lastname: Jiang
authors.forename: Jing
authors.initials: J
authors.lastname: Xiang
authors.forename: Qian
authors.initials: Q
authors.lastname: Huang
authors.forename: Jun Ping
authors.initials: JP
authors.lastname: Shi
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D044466:Asian People / Q000706:statistics & numerical data; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology*; D008111:Liver Function Tests / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D010976:Platelet Count; D015995:Prevalence; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase