title: External validation of the non-alcoholic fatty liver disease fibrosis score for assessing advanced fibrosis in Korean patients.
abstract: BACKGROUND
  The degree of liver fibrosis in non-alcoholic fatty liver disease (NAFLD) is a critical predictive factor for patient prognosis. This study was intended to perform external validation of the various fibrosis prediction models for assessing advanced fibrosis in Korean NAFLD patients.
  
  
  METHODS
  A retrospective study of 412 patients with NAFLD confirmed by liver biopsy in hospitals affiliated with the Koran NAFLD study group was conducted and the predictive ability of existing liver fibrosis prediction models including NAFLD fibrosis score (NFS), BARD, and fibrosis-4 were compared.
  
  
  RESULTS
  Among 412 samples, 328 liver slides were suitable for evaluation. Advanced fibrosis was present in 60 (18.3%) of the patient samples. Univariate analysis found that the group with advanced fibrosis showed low alanine aminotransferase values and high aspartate aminotransferase/alanine aminotransferase ratios as well as a high incidence of diabetes. However, multivariate analysis showed that only the presence of diabetes and triglycerides was independent risk factors. The receiver operating characteristic was 0.64 in NFS, 0.58 in fibrosis-4, and 0.594 in the BARD model. The NFS was found to be the best at predicting advanced fibrosis among the three prediction models. The negative predictive value which predicts advanced fibrosis using the low cutoff (<-1.455) was high (86.6%). However, the positive predictive value which predicts advanced fibrosis using the high cutoff (>0.676) was 50.0% when we applied the NFS.
  
  
  CONCLUSIONS
  Negative predictive value using the low cutoff value was high, but positive predictive value using the high cutoff value was low in a Korean NAFLD cohort using NFS.
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Jun
authors.affiliation: Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon, South Korea.
authors.forename: Sang Gyune
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology Kangnam, Sacred Heart Hospital Hallym University Medical Center, Bucheon, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Pathology, Soon Chun Hyang University Seoul Hospital, Seoul, South Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Jin
authors.affiliation: Clinical Research Center, Asan Medical Center, Seoul, South Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Seoul, South Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kangbuk SaProfessorung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Guri, South Korea.
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Sohn
mesh_terms: D000328:Adult; D044466:Asian People; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: NAFLD; NASH; clinical; metabolism