The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD

Paul Angulo, Jason M. Hui, Giulio Marchesini, Ellisabetta Bugianesi, Jacob George, Geoffrey C. Farrell, Felicity T Enders, Sushma Saksena, Alastair D. Burt, John P. Bida, Keith Lindor, Schuyler O. Sanderson, Marco Lenzi, Leon A. Adams, James Kench, Terry M Therneau, Christopher P. Day

Research output: Contribution to journalArticle

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Abstract

Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%). Conclusion: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.

Original languageEnglish (US)
Pages (from-to)846-854
Number of pages9
JournalHepatology
Volume45
Issue number4
DOIs
StatePublished - Apr 2007

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Liver Cirrhosis
Fibrosis
Biopsy
End Stage Liver Disease
Liver
Platelet Count
ROC Curve
Hyperglycemia
Non-alcoholic Fatty Liver Disease
Albumins
Body Mass Index
Demography

ASJC Scopus subject areas

  • Hepatology

Cite this

Angulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., ... Day, C. P. (2007). The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology, 45(4), 846-854. https://doi.org/10.1002/hep.21496

The NAFLD fibrosis score : A noninvasive system that identifies liver fibrosis in patients with NAFLD. / Angulo, Paul; Hui, Jason M.; Marchesini, Giulio; Bugianesi, Ellisabetta; George, Jacob; Farrell, Geoffrey C.; Enders, Felicity T; Saksena, Sushma; Burt, Alastair D.; Bida, John P.; Lindor, Keith; Sanderson, Schuyler O.; Lenzi, Marco; Adams, Leon A.; Kench, James; Therneau, Terry M; Day, Christopher P.

In: Hepatology, Vol. 45, No. 4, 04.2007, p. 846-854.

Research output: Contribution to journalArticle

Angulo, P, Hui, JM, Marchesini, G, Bugianesi, E, George, J, Farrell, GC, Enders, FT, Saksena, S, Burt, AD, Bida, JP, Lindor, K, Sanderson, SO, Lenzi, M, Adams, LA, Kench, J, Therneau, TM & Day, CP 2007, 'The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD', Hepatology, vol. 45, no. 4, pp. 846-854. https://doi.org/10.1002/hep.21496
Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC et al. The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007 Apr;45(4):846-854. https://doi.org/10.1002/hep.21496
Angulo, Paul ; Hui, Jason M. ; Marchesini, Giulio ; Bugianesi, Ellisabetta ; George, Jacob ; Farrell, Geoffrey C. ; Enders, Felicity T ; Saksena, Sushma ; Burt, Alastair D. ; Bida, John P. ; Lindor, Keith ; Sanderson, Schuyler O. ; Lenzi, Marco ; Adams, Leon A. ; Kench, James ; Therneau, Terry M ; Day, Christopher P. / The NAFLD fibrosis score : A noninvasive system that identifies liver fibrosis in patients with NAFLD. In: Hepatology. 2007 ; Vol. 45, No. 4. pp. 846-854.
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abstract = "Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93{\%} and 88{\%} in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90{\%} and 82{\%} in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75{\%}) of the 733 patients, with correct prediction in 496 (90{\%}). Conclusion: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.",
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AU - Angulo, Paul

AU - Hui, Jason M.

AU - Marchesini, Giulio

AU - Bugianesi, Ellisabetta

AU - George, Jacob

AU - Farrell, Geoffrey C.

AU - Enders, Felicity T

AU - Saksena, Sushma

AU - Burt, Alastair D.

AU - Bida, John P.

AU - Lindor, Keith

AU - Sanderson, Schuyler O.

AU - Lenzi, Marco

AU - Adams, Leon A.

AU - Kench, James

AU - Therneau, Terry M

AU - Day, Christopher P.

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N2 - Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%). Conclusion: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.

AB - Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%). Conclusion: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.

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