title: Performance of non-invasive models of fibrosis in predicting mild to moderate fibrosis in patients with non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  In non-alcoholic fatty liver disease, presence of fibrosis is predictive of long-term liver-related complications. Currently, there are no reliable and non-invasive means of quantifying fibrosis in those with non-alcoholic fatty liver disease. Therefore, we aimed to evaluate the performance of a panel of non-invasive models in predicting fibrosis in non-alcoholic fatty liver disease.
  
  
  METHODS
  The accuracy of FibroMeter non-alcoholic fatty liver disease, fibrosis 4 and four other non-invasive models in predicting fibrosis in those with biopsy proven non-alcoholic fatty liver disease was compared. These models were constructed post hoc in patients who had necessary clinical information collected within 2 months of a liver biopsy. The areas under receiver operating characteristics curves were compared for each model using Delong analysis. Optimum cut-off for each model and fibrosis stage were calculated using the Youden index.
  
  
  RESULTS
  The area under receiver operating characteristics curves for F ≥ 1 fibrosis for fibrosis 4 and FibroMeter non-alcoholic fatty liver disease was 0.821 and 0.801 respectively. For F ≥ 3, the area under receiver operating characteristics curves was 0.866 for fibrosis 4 and 0.862 for FibroMeter non-alcoholic fatty liver disease. Delong analysis showed the area under receiver operating characteristics curves was statistically different for fibrosis 4 and FibroMeter non-alcoholic fatty liver disease compared with BARD, BAAT and aspartate aminotransferase:alanine aminotransferase ratio for F ≥ 1 and F ≥ 3. Area under receiver operating characteristics curves were significantly different for fibrosis 4 and FibroMeter non-alcoholic fatty liver disease for F ≥ 3 compared with non-alcoholic fatty liver disease fibrosis score. At a fixed sensitivity of 90%, FibroMeter non-alcoholic fatty liver disease had the highest specificity for F ≥ 1 (52.4%) and F ≥ 3 (63.8%). In contrast, at a fixed specificity of 90%, fibrosis 4 outperformed other models with a sensitivity of 60.2% for F ≥ 1 and 70.6% for F ≥ 3 fibrosis.
  
  
  CONCLUSIONS
  These non-invasive models of fibrosis can predict varying degrees of fibrosis from routinely collected clinical information in non-alcoholic fatty liver disease.
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Siddiqui
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Kavish R
authors.initials: KR
authors.lastname: Patidar
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Boyett
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Puri
authors.affiliation: Division of Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001792:Blood Platelets; D015992:Body Mass Index; D004796:Clinical Enzyme Tests; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: FibroMeter non-alcoholic fatty liver disease; fibrosis; fibrosis 4; non-alcoholic fatty liver disease