Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events : A systematic review
© 2020 The Authors. Liver International published by John Wiley & Sons Ltd..
BACKGROUND & AIMS: Fibrosis is the strongest predictor for long-term clinical outcomes among patients with non-alcoholic fatty liver disease (NAFLD). There is growing interest in employing non-invasive methods for risk stratification based on prognosis. FIB-4, NFS and APRI are models commonly used for detecting fibrosis among NAFLD patients. We aimed to synthesize existing literature on the ability of these models in prognosticating NAFLD-related events.
METHODS: A sensitive search was conducted in two medical databases to retrieve studies evaluating the prognostic accuracy of FIB-4, NFS and APRI among NAFLD patients. Target events were change in fibrosis, liver-related event and mortality. Two reviewers independently performed reference screening, data extraction and quality assessment (QUAPAS tool).
RESULTS: A total of 13 studies (FIB-4:12, NFS: 11, APRI: 10), published between 2013 and 2019, were retrieved. All studies were conducted in a secondary or tertiary care setting, with follow-up ranging from 1 to 20 years. All three markers showed consistently good prognostication of liver-related events (AUC from 0.69 to 0.92). For mortality, FIB-4 (AUC of 0.67-0.82) and NFS (AUC of 0.70-0.83) outperformed APRI (AUC of 0.52-0.73) in all studies. All markers had inconsistent performance for predicting change in fibrosis stage.
CONCLUSIONS: FIB-4, NFS, and APRI have demonstrated ability to risk stratify patients for liver-related morbidity and mortality, with comparable performance to a liver biopsy, although more head-to-head studies are needed to validate this. More refined models to prognosticate NAFLD-events may further enhance performance and clinical utility of non-invasive markers.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
Liver international : official journal of the International Association for the Study of the Liver - 41(2021), 2 vom: 27. Feb., Seite 261-270 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Jenny [VerfasserIn] |
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| Links: |
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| Themen: |
Biomarker |
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| Anmerkungen: |
Date Completed 21.06.2021 Date Revised 21.06.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1111/liv.14669 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315181036 |
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| 100 | 1 | |a Lee, Jenny |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events |b A systematic review |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 21.06.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Liver International published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND & AIMS: Fibrosis is the strongest predictor for long-term clinical outcomes among patients with non-alcoholic fatty liver disease (NAFLD). There is growing interest in employing non-invasive methods for risk stratification based on prognosis. FIB-4, NFS and APRI are models commonly used for detecting fibrosis among NAFLD patients. We aimed to synthesize existing literature on the ability of these models in prognosticating NAFLD-related events | ||
| 520 | |a METHODS: A sensitive search was conducted in two medical databases to retrieve studies evaluating the prognostic accuracy of FIB-4, NFS and APRI among NAFLD patients. Target events were change in fibrosis, liver-related event and mortality. Two reviewers independently performed reference screening, data extraction and quality assessment (QUAPAS tool) | ||
| 520 | |a RESULTS: A total of 13 studies (FIB-4:12, NFS: 11, APRI: 10), published between 2013 and 2019, were retrieved. All studies were conducted in a secondary or tertiary care setting, with follow-up ranging from 1 to 20 years. All three markers showed consistently good prognostication of liver-related events (AUC from 0.69 to 0.92). For mortality, FIB-4 (AUC of 0.67-0.82) and NFS (AUC of 0.70-0.83) outperformed APRI (AUC of 0.52-0.73) in all studies. All markers had inconsistent performance for predicting change in fibrosis stage | ||
| 520 | |a CONCLUSIONS: FIB-4, NFS, and APRI have demonstrated ability to risk stratify patients for liver-related morbidity and mortality, with comparable performance to a liver biopsy, although more head-to-head studies are needed to validate this. More refined models to prognosticate NAFLD-events may further enhance performance and clinical utility of non-invasive markers | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a biomarker | |
| 650 | 4 | |a non-alcoholic fatty liver disease | |
| 650 | 4 | |a prognostic accuracy | |
| 700 | 1 | |a Vali, Yasaman |e verfasserin |4 aut | |
| 700 | 1 | |a Boursier, Jerome |e verfasserin |4 aut | |
| 700 | 1 | |a Spijker, Rene |e verfasserin |4 aut | |
| 700 | 1 | |a Anstee, Quentin M |e verfasserin |4 aut | |
| 700 | 1 | |a Bossuyt, Patrick M |e verfasserin |4 aut | |
| 700 | 1 | |a Zafarmand, Mohammad H |e verfasserin |4 aut | |
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