Evaluation of Liver Biopsy Findings and Comparison with Noninvasive Fibrosis Scores in Patients with Non-Alcoholic Steatohepatitis

OBJECTIVE: Nowadays, the incidence of non-alcoholic fatty liver and steatohepatitis (NASH) is increasing and early diagnosis is of great importance. In this study, we investigated the place of Fibrosis-4 (FIB-4), Aspartate Aminotransferase to Platelet Ratio (APRI) and AST/ALT Ratio in predicting liver fibrosis and its most optimal cut-off value in NASH patients undergoing liver biopsy. METHOD: Patients with NASH who underwent liver biopsy were included in the study. Biopsy results of all patients were evaluated histopathologically and grade of fibrosis was graded. In addition, FIB-4, APRI and AST/ALT scores were calculated and compared with biopsy findings in these patients. RESULTS: A total of 88 patients were included in the study. Of these patients 51 (58%) were female and the mean age of the study population was 52.7±9.5. According to biopsy results, NASH was detected in 79 (89.8%) and NAFLD in 9 (10.2%) patients. The cut-off values of <0.47 for APRI and <0.88 for FIB-4 scores showed the best discriminatory power in exclusion of liver fibrosis. Likewise, the cut-off value greater than 0.68 for APRI score and >2.16 for FIB-4 score showed the highest predictive value in predicting advanced fibrosis. AST/ALT ratio had not any diagnostic value. CONCLUSION: FIB-4 and APRI scores play an important role in the noninvasive prediction of fibrosis in NASH patients, but the AST/ALT ratio is not sufficient. On the other hand, although the guidelines recommend using these scoring systems as a screening tool, there is no clarity as to the appropriate ideal cut-off values. At this point, FIB-4 score stands out with high sensitivity and specificity especially in the prediction of severe fibrosis.