title: Can FIB4 and NAFLD fibrosis scores help endocrinologists refer patients with non-alcoholic fat liver disease to a hepatologist?
abstract: OBJECTIVE
  The objective of this study is to evaluate the performance of mathematical models used in non-invasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients to determine when the patient needs to be referred to a hepatologist.
  
  
  METHODS
  Patients referred by endocrinologists to the liver outpatient departments in two hospitals in Curitiba, Brazil, over a 72-month period were analyzed. The results calculated using the APRI, FIB 4, FORNS and NAFLD Fibrosis Score non-invasive liver fibrosis assessment models were analyzed and compared with histological staging of this population.
  
  
  RESULTS
  Sixty-seven patients with NAFLD were analyzed. Forty-two of them (62.68%) were female, mean age was 54.76 (±9.63) years, mean body mass index 31.42 (±5.64) and 59 (88.05%) of the 67 cases had glucose intolerance or diabetes. A diagnosis of steatohepatitis was made in 45 (76.27%) of the 59 biopsied patients, and advanced liver fibrosis (stages 3 and 4) was diagnosed in 18 (26.86%) of the 67 patients in the study population. The FIB 4 and NAFLD Fibrosis Score models had a high negative predictive value (93.48% and 93.61%, respectively) in patients with severe liver fibrosis (stages 3 and 4).
  
  
  CONCLUSIONS
  In conclusion, use of the FIB 4 and NAFLD Fibrosis Score models in NAFLD patients allows a diagnosis of severe liver disease to be excluded.
authors.affiliation: Serviço de Gastroenterologia, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil.
authors.forename: Rodrigo Bremer
authors.initials: RB
authors.lastname: Nones
authors.affiliation: Serviço de Gastroenterologia, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil.
authors.forename: Cláudia Pontes
authors.initials: CP
authors.lastname: Ivantes
authors.affiliation: Unidade de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil.
authors.forename: Maria Lucia Alves
authors.initials: MLA
authors.lastname: Pedroso
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D000072097:Endocrinologists; D005260:Female; D000072102:Gastroenterologists; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D065626:Non-alcoholic Fatty Liver Disease / Q000473:pathology*; D012015:Reference Standards; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase