Department of Internal Medicine - Gastroenterology Unit, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil and Santa Casa Hospital de Porto Alegre, Brazil.
Eur J Gastroenterol Hepatol. 2020 Mar;32(3):420-425. doi: 10.1097/MEG.0000000000001519.
Liver fibrosis is one of the most important predictors of mortality related to nonalcoholic fatty liver disease (NAFLD). The use of noninvasive markers has the advantage of a simple and low-cost evaluation. The aim of this study was to evaluate the performance of six noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese patients.
A retrospective study validation included 323 morbidly obese patients undergoing bariatric surgery. Advance fibrosis was defined as stage 3 and 4 (septal fibrosis or cirrhosis). Accuracy, sensitivity, specificity, positive (PPV) or negative (NPV) predictive value, and positive (PLR) or negative (NLR) likelihood ratio test of the following noninvasive liver fibrosis scores were evaluated: aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR); AST to platelet ratio index (APRI); BARD; FIB4, NAFLD fibrosis score (NFS) and BAAT, which were compared with the histological findings of the intraoperative liver biopsy. The cutoff points established in the validation studies were used: AAR > 1; APRL > 0.98; BARD ≥ 2; FIB4 > 2.67; NFS > 0.676 and BAAT > 1.
Twenty-nine patients (8.97%) presented advanced fibrosis. APRI presented the higher specificity (99.61%), PPV (85.71%), PLR (62.5) and accuracy (0.93). FIB4 was the second test in accuracy (0.9) and in PLR (10.53). BAAT presented the highest sensitivity (73.08%) and NPV (94.78%); NFS the lowest sensitivity (12,5%), and BARD the lowest accuracy (0.44).
APRI and FIB-4 were the tests with best performance to predict advanced fibrosis.
肝纤维化是与非酒精性脂肪性肝病（NAFLD）相关死亡率的最重要预测因素之一。使用非侵入性标志物具有简单且成本低的评估优势。本研究旨在评估六种非侵入性评分系统在病态肥胖患者中诊断晚期肝纤维化的性能。
一项回顾性研究验证包括 323 例接受减肥手术的病态肥胖患者。进展性纤维化定义为 3 期和 4 期（间隔纤维化或肝硬化）。评估以下非侵入性肝纤维化评分的准确性、敏感性、特异性、阳性（PPV）或阴性（NPV）预测值以及阳性（PLR）或阴性（NLR）似然比试验：天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值（AAR）；AST 与血小板比值指数（APRI）；BARD；FIB4、NAFLD 纤维化评分（NFS）和 BAAT，并与术中肝活检的组织学发现进行比较。验证研究中确定的截止值为：AAR＞1；APRI＞0.98；BARD≥2；FIB4＞2.67；NFS＞0.676 和 BAAT＞1。
29 例患者（8.97%）存在进展性纤维化。APRI 具有最高的特异性（99.61%）、PPV（85.71%）、PLR（62.5）和准确性（0.93）。FIB4 在准确性（0.9）和 PLR（10.53）方面排名第二。BAAT 具有最高的敏感性（73.08%）和 NPV（94.78%）；NFS 具有最低的敏感性（12.5%），BARD 具有最低的准确性（0.44）。
APRI 和 FIB-4 是预测晚期纤维化的最佳检测方法。
