Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
Department of Medicine, Division of Gastroenterology, Division of Gastroenterology and Hepatology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
World J Gastroenterol. 2022 Apr 21;28(15):1563-1573. doi: 10.3748/wjg.v28.i15.1563.
Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease (NAFLD) management. The fibrosis-8 (FIB-8) score, recently developed by incorporating four additional variables into the fibrosis-4 (FIB-4) score, showed better performance in predicting significant fibrosis in NAFLD.
To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score (NFS) for predicting significant fibrosis.
We collected the data of biopsy-proven NAFLD patients from three Asian centers in three countries. All the patients with available variables for the FIB-4 score (age, platelet count, and aspartate and alanine aminotransferase levels) and FIB-8 score (the FIB-4 variables plus 4 additional parameters: The body mass index (BMI), albumin to globulin ratio, gamma-glutamyl transferase level, and presence of diabetes mellitus) were included. The fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria, and significant fibrosis was defined as at least fibrosis stage 2.
A total of 511 patients with biopsy-proven NAFLD and complete data were included for validation. Of these 511 patients, 271 (53.0%) were female, with a median age of 51 (interquartile range: 41, 58) years. The median BMI was 29 (26.3, 32.6) kg/m, and 268 (52.4%) had diabetes. Among the 511 NAFLD patients, 157 (30.7%) had significant fibrosis (≥ F2). The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774, 0.743, and 0.680, respectively. The FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS ( = 0.001) and was also clinically superior to FIB-4, although statistical significance was not reached ( = 0.073). The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36% sensitivity, and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.77 showed 67.51% specificity.
We demonstrated that the FIB-8 score had significantly better performance for predicting significant fibrosis in NAFLD patients than the NFS, as well as clinically superior performance the FIB-4 score in an Asian population. A novel simple fibrosis score comprising commonly accessible basic laboratories may be beneficial to use for an initial assessment in primary care units, excluding patients with significant liver fibrosis and aiding in patient selection for further hepatologist referral.
识别肝纤维化对于非酒精性脂肪性肝病（NAFLD）的管理至关重要。最近，通过将四个附加变量纳入纤维化-4 （FIB-4）评分中，开发了纤维化-8 （FIB-8）评分，该评分在预测 NAFLD 中的显著纤维化方面表现出更好的性能。
在经活检证实的 NAFLD 队列中验证 FIB-8 评分，并比较 FIB-8 和 FIB-4 评分以及 NAFLD 纤维化评分（NFS）在预测显著纤维化方面的诊断性能。
我们从三个亚洲国家的三个中心收集了经活检证实的 NAFLD 患者的数据。所有患者均具有 FIB-4 评分（年龄、血小板计数、天冬氨酸和丙氨酸氨基转移酶水平）和 FIB-8 评分（FIB-4 变量加 4 个附加参数：体重指数（BMI）、白蛋白与球蛋白比值、γ-谷氨酰转移酶水平和糖尿病存在）的可用变量。使用非酒精性脂肪性肝炎 CRN 标准对纤维化阶段进行评分，至少纤维化阶段 2 定义为显著纤维化。
共有 511 名经活检证实的 NAFLD 患者和完整数据被纳入验证。这 511 名患者中，271 名（53.0%）为女性，中位年龄为 51（四分位距：41，58）岁。中位 BMI 为 29（26.3，32.6）kg/m，268 名（52.4%）患有糖尿病。在 511 名 NAFLD 患者中，157 名（30.7%）有显著纤维化（≥F2）。FIB-8 和 FIB-4 评分以及 NFS 预测显著纤维化的受试者工作特征曲线下面积分别为 0.774、0.743 和 0.680。FIB-8 评分在预测显著纤维化方面的表现明显优于 NFS（=0.001），并且在临床方面也优于 FIB-4，尽管未达到统计学意义（=0.073）。FIB-8 评分预测显著纤维化的低截断值为 0.88，其灵敏度为 92.36%，高截断值为 1.77，其特异性为 67.51%。
我们证明，与 NFS 相比，FIB-8 评分在预测 NAFLD 患者的显著纤维化方面具有显著更好的性能，并且在亚洲人群中，与 FIB-4 评分相比具有更好的临床性能。一种新的简单纤维化评分包括通常可获得的基本实验室检查结果，可能有益于在初级保健单位进行初步评估，排除具有显著肝纤维化的患者，并有助于为进一步的肝病专家转诊选择患者。
