Giammarino Alexa, Shah Nairuti, Ghani Maham, Ali Hassam, Satapathy Sanjaya K
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Gastroenterology and Transplant Hepatology, New Hyde Park, NY, 11040, USA.
NYU Langone Hospital - Long Island Department of Medicine, Mineola, NY, 11501, USA.
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102556. doi: 10.1016/j.jceh.2025.102556. Epub 2025 Mar 25.
Currently, the Fibrosis-4 (FIB-4) and nonalcoholic fatty liver disease fibrosis score (NFS) are used to predict fibrosis and steatosis in patients with or at risk for metabolic dysfunction-associated steatotic liver disease (MASLD). More recently, the fibrotic nonalcoholic steatohepatitis (NASH) index (FNI) and steatosis-associated fibrosis estimator (SAFE) have been created. We have compared the accuracy of these noninvasive scoring systems in MASLD patients.
This is a retrospective analysis of 244 biopsy-proven MASLD patients from a tertiary health care system. Score performances were determined by calculating the area under the receiver operating characteristic (AUROC) curve with 95% confidence intervals, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).
About 25 (10.3%) patients had fibrotic metabolic dysfunction-associated steatohepatitis (MASH). The FNI score was best at predicting fibrotic MASH with an AUROC of 0.78, while NFS was the worst at predicting fibrotic NASH with an AUROC of 0.60. In the entire cohort, FNI of 0.33, FIB-4 of 2.67, SAFE >100, and NFS >0.675 had PPVs of 17%, 31%, 17%, and 16%, respectively, and NPVs of 97%, 92%, 96%, and 91%, respectively. Specificity was greatest for FIB4 at 92% and NFS at 86%, whereas the sensitivity was greatest for FNI and SAFE scores at 88% and 80%, respectively.
FNI and SAFE scores have superior diagnostic accuracy for fibrotic MASH compared to other scoring systems. While liver biopsy remains the gold standard diagnostic method, noninvasive scores like FNI, and SAFE scores can be used in everyday clinical practice to assess for fibrotic MASH.
目前，纤维化-4（FIB-4）和非酒精性脂肪性肝病纤维化评分（NFS）用于预测代谢功能障碍相关脂肪性肝病（MASLD）患者或有该疾病风险患者的纤维化和脂肪变性。最近，已创建了纤维化非酒精性脂肪性肝炎（NASH）指数（FNI）和脂肪变性相关纤维化评估器（SAFE）。我们比较了这些非侵入性评分系统在MASLD患者中的准确性。
这是一项对来自三级医疗保健系统的244例经活检证实的MASLD患者的回顾性分析。通过计算受试者操作特征（AUROC）曲线下面积及95%置信区间、敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）来确定评分表现。
约25例（10.3%）患者患有纤维化代谢功能障碍相关脂肪性肝炎（MASH）。FNI评分在预测纤维化MASH方面表现最佳，AUROC为0.78，而NFS在预测纤维化NASH方面表现最差，AUROC为0.60。在整个队列中，FNI为0.33、FIB-4为2.67、SAFE>100和NFS>0.675时，阳性预测值分别为17%、31%、17%和16%，阴性预测值分别为97%、92%、96%和91%。FIB4的特异性最高，为92%，NFS为86%，而FNI和SAFE评分的敏感性最高，分别为88%和80%。
与其他评分系统相比，FNI和SAFE评分对纤维化MASH具有更高的诊断准确性。虽然肝活检仍然是金标准诊断方法，但像FNI和SAFE评分这样的非侵入性评分可用于日常临床实践中评估纤维化MASH。
