Noninvasive Assessment of Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Table 1

Noninvasive fibrosis serum tests and scores to diagnose nonalcoholic steatohepatitis (NASH) and/or stage fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) [12].

Test	Variables	NAFLD stage assessed	Cut-off	AUROC
AST : ALT ratio	ALT and AST serum levels	F4	1	NA
CK-18	Cytokeratin 18 fragments	NAFLD; NASH; Fibrosis (any degree)	NA	0.77; 0.65–0.83; 0.68
Ferritin	Serum ferritin	NASH/≥F2; ≥F3	1.5 ULN; 2.5 ULN	0.57; NA
NASH diagnostic	CK-18 fragments, adiponectin, and resistin	NASH	0.43	0.70–0.85
NASH diagnostic panel	Gender, BMI, diabetes, triglycerides, and CK-18 (total levels and fragments)	NASH	NA	0.81
NashTest	Age, gender, weight, height, bilirubin, GGT, 2-macroglobulin, apolipoprotein A1, haptoglobin, AST, serum glucose, triglycerides, and cholesterol	No NASH; Borderline NASH; NASH	NA	NA; NA; 0.69–0.83
NAFIC scoring system	Ferritin ≥200 or ≥300 ng/mL (F or M) = 1; Serum fasting insulin ≥10 μU/mL = 1; Serum type IV collagen 7s ≥5.0 ng/mL = 2	NASH	2	0.78–0.85
Modified NAFIC; scoring system	Ferritin ≥200 or ≥300 ng/mL (F or M) = 1; Serum fasting insulin ≥10 < 15 μU/mL = 1; Serum fasting insulin ≥15 = 2; Serum type IV collagen 7s ≥5.0 ng/mL = 2	NASH	2	0.80
PIIINP	Terminal peptide of procollagen III levels	NASH; ≥F3	6.6 ng/mL (low cut-off); 11 ng/mL (high cut-off)	0.82; 0.84
APRI	AST, PLT	≥F2	0.45 (low cut-off); 1.5 (high cut-off)	0.62–0.94
BARD	BMI, AST/ALT ratio, and diabetes	≥F3	≥2	0.80
BARDI	BMI, AST/ALT ratio, diabetes, and INR	≥F3	≥3	0.88
NAFLD fibrosis score	Age, BMI, diabetes. AST, ALT, platelet count, and albumin	≥F3	−1.45 (low cut-off); 0.67 (high cut-off)	0.82–0.88
FIB-4	Age, AST, ALT, and platelet count	≥F3	1.3–1.92 (low cut-off); 3.25 (high cut-off)	0.87, 0.88
Hepascore	Age, sex, bilirubin, GGT, α2-macroglobulin, and hyaluronic acid	≥F2; ≥F3; F4	0.44; 0.37; 0.7	0.73; 0.81; 0.9
ELF test	Hyaluronic acid (HA), PIIINP, and tissue inhibitor of metalloproteinase 1 (TIMP-1).	≥F2; ≥F3; F4	8.5–10.18; 10.35 (9.33–10.51); 9.35–11.3	0.82; 0.90; 0.87
FibroTest	Haptoglobin, α2-macroglobulin, apolipoprotein-A, bilirubin, and GGT	≥F3	0.3 (low cut-off); 0.7 (high cut-off)	0.88
FibroMeter	Age, weight, glucose, AST, ALT, PLT, and ferritin	≥F2; ≥F3; F4	F3: 0.61 (low cut-off); 0.71 (high cut-off)	0.94; 0.93; 0.9

ALT: alanine aminotransferase; AST: aspartate aminotransferase; AUROC: area under receiver operator characteristic curve; CK-18: cytokeratin 18; NA: not available; BMI: body mass index; GGT: -glutamyl transpeptidase; PLT: platelets; PIIINP: terminal peptide of procollagen III; APRI: aspartate aminotransferase to platelets ratio; INR: international normalized ratio; ELF: enhanced liver fibrosis; ULN: upper limit of normal.