Fibroscan versus simple noninvasive screening tools in predicting fibrosis in high-risk nonalcoholic fatty liver disease patients from Western India

BACKGROUND: The aim of the study was to determine the efficacy of Fibroscan versus noninvasive markers, i.e. nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS); Aspartate-aminotransferase (AST)/platelet ratio (APRI); and AST/Alanine-aminotransferase (AAR) as a screening tool in NAFLD patients with high risk of liver fibrosis. METHODS: This is a single-center study carried out in patients attending the outpatient department for dyspepsia and diagnosed with fatty liver on ultrasound. Liver biopsy was advised in diabetics, metabolic syndrome, body mass index >30 kg/m(2), raised transaminases and hypothyroidism. Fibroscan, APRI, AAR and NFS were calculated. Area under the curve (AUROC), negative (NPV) and positive predictive values (PPV) were calculated for each diagnostic test. RESULTS: Of the 1500 patients screened, 110 with the above-described risk factors underwent liver biopsy (stage 3/4 fibrosis = 38). Diabetes predicted severe fibrosis (stage 3/4). Sensitivity, specificity, PPV, NPV and AUROC for Fibroscan at value 12 kPa were 0.9, 0.8, 0.70, 0.93 and 0.91 respectively for predicting stage 3/4 fibrosis. With increase in severity of liver fibrosis there was stepwise increase in Fibroscan values (P=0.000038, Kruskal-Wallis test). Sensitivity, specificity, PPV and NPV for AAR and NFS at cutoff of 1.5 and 0.676 were 0.8, 1.0, 1.0 and 0.92 and 0.8, 1.0, 1.0 and 0.92 respectively. CONCLUSION: Fibroscan, NFS and AAR are simple noninvasive markers of fibrosis that can be utilized as screening tools in patients with high risk for fibrosis to determine the need for biopsy. The cutoff of Fibroscan for stage 3/4 fibrosis was 12 kPa.