title: Comparison of noninvasive scores for the detection of advanced fibrosis in patients with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  The presence of advanced liver fibrosis portends a poor prognosis in nonalcoholic fatty liver disease (NAFLD). We aimed to compare the diagnostic performance of five noninvasive scores [aspartate aminotransferase/platelet ratio (APRI), BARD, FIB-4, NAFLD fibrosis score (NFSA), and FibroMeter] for the assessment of advanced stages of fibrosis (F ≥ 3) in patients with biopsy-proven NAFLD.
  
  
  METHODS
  APRI, BARD, FIB-4, NFSA, and FibroMeter scores were determined in 142 patients with NAFLD. The histopathological analysis of liver biopsies was considered the gold standard. Sensitivity and specificity were calculated for each noninvasive test using receiver operating characteristic (ROC) curve analysis, with a cut-off value of F ≥ 3 for advanced fibrosis. The diagnostic accuracies were assessed by measuring the area under the ROC curve (AUROC). The AUROCs for different noninvasive tests were compared using paired significance tests.
  
  
  RESULTS
  At histopathological examination, 40 patients (28.2%) had a fibrosis stage F0, 50 patients (35.2%) had F1, 22 patients (15.5%) had F2, 20 patients (14.1%) had F3, and 10 patients (7.0%) had F4. The sensitivity of APRI, BARD, FIB-4, NFSA, and FibroMeter scores for advanced fibrosis was 70.0, 73.3, 70.0, 66.7, and 66.7%, respectively, and the specificity was 74.5, 66.4, 71.8, 71.8, and 74.5%, respectively. No significant differences in terms of sensitivity and specificity were evident for the five noninvasive scores. Moreover, the AUROCs did not differ significantly for all scores.
  
  
  CONCLUSIONS
  Our study suggests that different noninvasive scores have similar accuracy for the diagnosis of advanced hepatic fibrosis in NAFLD.
authors.affiliation: aDepartment of Internal Medicine, School of Medicine bInstitute of Gastroenterology cDepartment of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Cemal F
authors.initials: CF
authors.lastname: Subasi
authors.forename: Umut E
authors.initials: UE
authors.lastname: Aykut
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D010976:Platelet Count; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases