Non-alcoholic fatty liver disease Noninvasive scores

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

FIB-4 index at MedCalc and https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4 . For assessing need for biopsy in hepatitis B and hepatitis C.

NAFLD fibrosis score MedCalc

Fibrotic NASH Index (FNI) which contains the AST, HDL, HbA1c[1].

APRI MedCalc

The NAFLD-MESA Index uses "eight predictors: age, sex, race/ethnicity, type 2 diabetes, smoking history, body mass index, gamma-glutamyltransferase (GGT), and triglycerides (TG)"[2] The score predicted NAFLD by liver computed tomography (≤ 40 Hounsfield units indicating > 30% hepatic steatosis) with AUC = 0.80.

The LiverRisk score *https://www.liverriskscore.com/) may be more accurate than the FIB-4 or aspartate transferase to platelet ratio index (APRI) at predicting liver stiffness measurements of 6 kPa or more, 10 kPa or more, and 15 kPa[3]. These kPa thresholds correspond to:

  • 6 kPa: no fibrosis
  • 10 kPa: between F3 and F4 fibrosis
  • 15 kPa: above F4 fibrosis

Imaging

Liver stiffness measurements: "LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. LS highly correlates with portal pressure, and esophageal varices are likely at values >20 kPa."[4]

  • LS of 8 suggests F3 fibrosis
  • LS of 12.5 kPa suggests F4 fibrosis

CT scan: "≤ 40 Hounsfield units indicating > 30% hepatic steatosis"[2].

References

  1. Tavaglione F, Jamialahmadi O, De Vincentis A, Qadri S, Mowlaei ME, Mancina RM; et al. (2023). "Development and Validation of a Score for Fibrotic Nonalcoholic Steatohepatitis". Clin Gastroenterol Hepatol. 21 (6): 1523–1532.e1. doi:10.1016/j.cgh.2022.03.044. PMID 35421583 Check |pmid= value (help).
  2. 2.0 2.1 Rodriguez LA, Shiboski SC, Bradshaw PT, Fernandez A, Herrington D, Ding J; et al. (2021). "Predicting Non-Alcoholic Fatty Liver Disease for Adults Using Practical Clinical Measures: Evidence from the Multi-ethnic Study of Atherosclerosis". J Gen Intern Med. 36 (9): 2648–2655. doi:10.1007/s11606-020-06426-5. PMC 8390627 Check |pmc= value (help). PMID 33501527 Check |pmid= value (help).
  3. Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E; et al. (2023). "Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study". Lancet. doi:10.1016/S0140-6736(23)01174-1. PMID 37572680 Check |pmid= value (help).
  4. Mueller S, Sandrin L (2010). "Liver stiffness: a novel parameter for the diagnosis of liver disease". Hepat Med. 2: 49–67. doi:10.2147/hmer.s7394. PMC 3846375. PMID 24367208.

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