Zain, Shamsul Mohd and Tan, Hwa Li and Mohamed, Zahurin and Chan, Wah Kheong and Mahadeva, Sanjiv and Basu, Roma Choudhury and Mohamed, Rosmawati (2020) Use of simple scoring systems for a public health approach in the management of non‐alcoholic fatty liver disease patients. JGH Open, 4 (6). pp. 1155-1161. ISSN 2397-9070, DOI https://doi.org/10.1002/jgh3.12414.
Full text not available from this repository.Abstract
Background and Aim: Advanced fibrosis is the most important predictor of liver-related mortality in non-alcoholic fatty liver disease (NAFLD). The aim of this study was to compare the diagnostic performance of noninvasive scoring systems in identifying advanced fibrosis in a Malaysian NAFLD cohort and propose a simplified strategy for the management of NAFLD in a primary care setting. Methods: We enrolled and reviewed 122 biopsy-proven NAFLD patients. Advanced fibrosis was defined as fibrosis stages 3–4. Noninvasive assessments included aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST-to-platelet ratio index (APRI), AST/ALT ratio, diabetes (BARD) score, fibrosis-4 (FIB-4) score, and NAFLD fibrosis score. Results: FIB-4 score had the highest area under the receiver operating characteristic curve (AUROC) and negative predictive value (NPV) of 0.86 and 94.3%, respectively, for the diagnosis of advanced fibrosis. FIB-4 score < 1.3 ruled out advanced fibrosis in 72% of the patients, with 6% being understaged. Further stratification of the indeterminate group patients by other non-alcoholic steatohepatitis (NASH) clinical predictors, such as abnormal gamma-glutamyl transpeptidase (GGT) level and presence diabetes mellitus (DM), could further reduce the number of patients who are unlikely to have advanced fibrosis by 52% and 35%, respectively. Conclusion: We found that FIB-4 score outperforms other scoring systems based on AUROC and NPV. The use of a simple scoring system such as FIB-4 as first-line triage to risk-stratify NAFLD patients in the primary care setting, with further stratification of those in the indeterminate group using clinical predictors of NASH, can help in the development of a simplified strategy for a public health approach in the management of NAFLD. © 2020 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
| Item Type: | Article |
|---|---|
| Funders: | University of Malaya research grant (BK077-2016) |
| Uncontrolled Keywords: | advanced fibrosis; fatty liver; FIB-4; non-alcoholic fatty liver disease; scoring system |
| Subjects: | R Medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 08 Feb 2021 07:56 |
| Last Modified: | 08 Feb 2021 07:56 |
| URI: | http://eprints.um.edu.my/id/eprint/25721 |
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