Key result
APRI score accurately detects definite NASH and stage 3 fibrosis in obese patients.
Why the study?
Non-invasive tools for screening NAFLD and fibrosis in obese patients need evaluation as histologic evaluation is invasive and carries risks.
Do non-invasive scoring systems like APRI accurately screen for NAFLD and fibrosis in obese patients compared to histologic evaluation?
Cohort (n=141)
No
Do non-invasive scoring systems like APRI accurately screen for NAFLD and fibrosis in obese patients compared to histologic evaluation?
Effect estimate: AUROC 0.76
p-value: p=<0.0001
APRI is an affordable and easy-to-calculate non-invasive tool that provides good diagnostic accuracy for screening NAFLD and fibrosis in obese patients.
Non-invasive tools may aid NAFLD/fibrosis screening in obese patients; leaves open accuracy versus biopsy before routine adoption.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients. METHODS: In a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score. RESULTS: APRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score. CONCLUSIONS: APRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.
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Schmitz et al. (2020) conducted a cohort in Obesity with risk of Non-alcoholic fatty liver disease (NAFLD) (n=141). APRI score vs. Liver biopsy (histological evaluation) was evaluated on Differentiation of not NASH from definite NASH (AUROC 0.76, p=<0.0001). The APRI score accurately differentiated between not NASH and definite NASH (AUROC 0.76) and distinguished no fibrosis from stage 3 fibrosis (AUROC 0.81) in obese patients.
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