Is Aspartate Aminotransferase to Platelet Ratio Index a Better Noninvasive Score for Predicting Advanced Fibrosis in Nonalcoholic Fatty Liver Disease Patients?

Background: In the 21st century, nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder.The prevalence of NAFLD within the general population in India ranges from 9 to 53%.The gold standard for assessing the severity of liver fibrosis is liver biopsy.However, due to various difficulties involved with liver biopsy, it is imperative to identify different non-invasive tools that can replace liver biopsy.Methodology: A prospective observational study of 130 patients meeting the inclusion criteria for NAFLD was done for a period of 18 months.We aimed to compare the performance characteristics of different noninvasive scores fibrosis-4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI) in predicting advanced fibrosis as assessed by FibroScan.Results: In the study, 76.9% of patients were male.Advanced fibrosis was seen in 12.3% of the patients.Majority of the patients with advanced fibrosis had metabolic syndrome.Based on the area under the receiver operating characteristic curve (AUROC), the new cut-off for ruling out advanced fibrosis for FIB-4, NFS, and APRI were 1.18, -0.9, and 0.65, respectively, and APRI had the best AUROC (0.768).Conclusion: Abnormal glycemic status and metabolic syndrome were risk factors for advanced fibrosis.The newly derived cut-offs for the FIB-4 score, NFS score, and APRI score had a better Negative predictive value compared to the original cut-offs.