Abstract
BACKGROUND: Liver fibrosis worsens prognosis in metabolic dysfunction-associated fatty liver disease (MAFLD). FibroScan® is the most widely used noninvasive tool for evaluating fibrosis, but performing this assessment requires specialized equipment and expertise. This study aimed to assess the potential of four additional noninvasive techniques for diagnosing liver fibrosis that rely on routine laboratory measurements, that is, fibrosis (FIB)-4 score, FIB-5 score, aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, and the aspartate aminotransferase to platelet ratio index (APRI).
METHODS: This study was performed following a cross-sectional observational design at a tertiary care hospital in India. The study included adult patients who were observed to have elevated serum AST and ALT levels and fatty deposition on ultrasonography, as these indicate a risk for liver fibrosis, that is, MAFLD or metabolic dysfunction-associated steatohepatitis. The specificity and sensitivity of FIB-4, FIB-5, APRI, and AST/ALT ratio were compared with those of FibroScan® (FibroScan® 502, Echosens, Paris, France).
RESULTS: Among the alternative noninvasive methods, FIB-4 had the highest specificity (78%) and sensitivity (85%) that were closest to the specificity (88%) and sensitivity (92%) of FibroScan®. FIB-5 and APRI demonstrated moderate sensitivity (80% and 76%, respectively) and specificity (75 and 70%, respectively). The AST/ALT ratio had relatively poor diagnostic capability, with a specificity of 60% and sensitivity of 65%. The area under the curve (AUC) for the methods being compared was 0.82 (FIB-4), 0.79 (FIB-5), 0.74 (APRI), and 0.65 (AST/ALT ratio).
CONCLUSION: FibroScan® is the preferred option for evaluating liver fibrosis in patients with MAFLD. However, when unavailable, FIB-4 may be the next most reliable alternative for identifying or excluding advanced fibrosis. Other methods (FIB-5, APRI, and AST/ALT) are less accurate.