Comparison of Non-Alcoholic Fatty Liver Disease Fibrosis Score and Fibrosis-4 Index with Transient Elastography Results in the Evaluation of Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

Abstract

Background:

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common condition that can lead to serious liver complications. Transient elastography is a reliable, non-invasive, but expensive method for diagnosing fibrosis. This study compared the performance of non-alcoholic fatty liver disease (NAFLD) fibrosis score and fibrosis-4 (FIB-4) index as cheaper methods, with transient elastography in Mashhad, Iran.

Materials and Methods:

The study included 67 patients with MASLD. Demographic, laboratory, and elastography data were collected. Data were analyzed using SPSS software version 27 with two approaches: first, applying cutoffs from previous studies (NAFLD score > -1.455, elastography ≥ 8.7 kPa, FIB-4 > 1.30); second, calculating ROC curves to find optimal cutoffs for each index. P values ≤ 0.05 were significant.

Results:  

Based on previous cutoffs, the FIB-4 at 1.3 showed sensitivity 45%, specificity 97.8%, positive predictive value (PPV) 90%, and negative predictive value (NPV) 80%. The NAFLD score at -1.455 had a sensitivity of 55%, a specificity of 93.6%, a PPV of 78.5%, and an NPV of 83%. In this study, ROC analysis gave FIB-4 cutoff 1.335 with sensitivity 45%, specificity 100%, PPV 100%, and NPV 81%. The NAFLD score cutoff -1.93 showed sensitivity 75%, specificity 91.5%, PPV 79%, and NPV 89.5%.

Conclusion:

Based on the results, the NAFLD fibrosis score demonstrated better performance in ruling out the disease, while FIB-4 showed superior accuracy in diagnosing fibrosis. However, the combined use of multiple indices may reduce unnecessary referrals and improve the clinical management of patients.