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© 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background and Aim

Advanced fibrosis is the most important predictor of liver‐related mortality in non‐alcoholic fatty liver disease (NAFLD). The aim of this study was to compare the diagnostic performance of noninvasive scoring systems in identifying advanced fibrosis in a Malaysian NAFLD cohort and propose a simplified strategy for the management of NAFLD in a primary care setting.

Methods

We enrolled and reviewed 122 biopsy‐proven NAFLD patients. Advanced fibrosis was defined as fibrosis stages 3–4. Noninvasive assessments included aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST‐to‐platelet ratio index (APRI), AST/ALT ratio, diabetes (BARD) score, fibrosis‐4 (FIB‐4) score, and NAFLD fibrosis score.

Results

FIB‐4 score had the highest area under the receiver operating characteristic curve (AUROC) and negative predictive value (NPV) of 0.86 and 94.3%, respectively, for the diagnosis of advanced fibrosis. FIB‐4 score < 1.3 ruled out advanced fibrosis in 72% of the patients, with 6% being understaged. Further stratification of the indeterminate group patients by other non‐alcoholic steatohepatitis (NASH) clinical predictors, such as abnormal gamma‐glutamyl transpeptidase (GGT) level and presence diabetes mellitus (DM), could further reduce the number of patients who are unlikely to have advanced fibrosis by 52% and 35%, respectively.

Conclusion

We found that FIB‐4 score outperforms other scoring systems based on AUROC and NPV. The use of a simple scoring system such as FIB‐4 as first‐line triage to risk‐stratify NAFLD patients in the primary care setting, with further stratification of those in the indeterminate group using clinical predictors of NASH, can help in the development of a simplified strategy for a public health approach in the management of NAFLD.

Details

Title
Use of simple scoring systems for a public health approach in the management of non‐alcoholic fatty liver disease patients
Author
Shamsul Mohd Zain 1   VIAFID ORCID Logo  ; Hwa‐Li Tan 1 ; Zahurin Mohamed 1 ; Wah‐Kheong Chan 2   VIAFID ORCID Logo  ; Mahadeva, Sanjiv 2   VIAFID ORCID Logo  ; Roma Choudhury Basu 3 ; Rosmawati Mohamed 2 

 Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 
 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 
 Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia 
Pages
1155-1161
Section
Original Articles
Publication year
2020
Publication date
Dec 2020
Publisher
John Wiley & Sons, Inc.
e-ISSN
23979070
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2469062938
Copyright
© 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.