Assessment of Liver Fibrosis Grading with Non Invasive Scoring Systems Among Non Alcoholic Fatty Liver Disease (NAFLD) Patients

Abstract

Background: The evaluation of degree of liver fibrosis is an important prognostic factor in the management of NAFLD patients. Noninvasive risk stratification is needed to triage individuals with advanced fibrosis for optimal treatment and surveillance. Objective: To find the frequency of fibrosis in NAFLD patients using multiple non-invasive tests and to match the performance of noninvasive tests in diagnosing liver fibrosis. Methods: An observational study done in Out-patient Clinics of National Institute of Liver and GI diseases (NILGID), Dow University Hospital from January 2021 to January 2022. All consecutive NAFLD patients during the study period were enrolled. Liver fibrosis was assessed in each patient with non invasive scoring including APRI score (AST to platelet ratio index), AST/ALT ratio, NFS (NAFLD fibrosis scores) and FIB-4. Results: 322 patients (mean age 44.84 ±10.94 years) were included. The mean values for ALT and AST levels were 40.67 ± 31.69IU/L and 31.85 ± 22.60 respectively. The best diagnostic accuracy was observed with FIB4 score having AUROC of 0.904. A robust correlation was observed between APRI index and FIB-4 score (r = 0.734, p-value < 0.01), and between FIB-4 score and NFS score (r = 0.700, p- value <0.01). Whereas correlation of APRI index with NFS score was moderate (r=0.394), and with AST/ALT ratio was weak (r = 0.201). Conclusion: Noninvasive markers, FIB4 and NFS score demonstrate a dependable ability to diagnose and rule out liver fibrosis, which proves to be an economical approach in management of patients with NAFLD.