Evaluation of the noninvasive fibrosis tests in nonalcoholic steatohepatitis patients

The parameter that has the strongest relationship with liver-related complications and liver-related mortality in nonalcoholic steatohepatitis(NASH) patients is the fibrosis stage. The current gold standard test for the diagnosis of NASH is liver biopsy. However, because of the limitations of liver biopsy, there is an ongoing need for noninvasive methods that can accurately detect the fibrosis stage. The main aim of this study is to develop a new noninvasive scoring system that can predict hepatic fibrosis by using the most relevant variables among the demographic, clinical, laboratory, imaging data and 7 serum fibrosis biomarkers. 56 patients diagnosed as NASH by liver biopsy were prospectively enrolled in the study. Participants were divided into four groups according to fibrosis stage and a comparison was made for a total of 59 variables. Among the variables with statistically significant differences between the groups, total metabolic syndrome score(p=0.001), AST/ALT ratio(p<0.001) and MMP-1(p=0.009) variables were used in binary logistic regression analysis to develop a new scoring system. The diagnostic accuracy of this new score in detecting patients with fibrosis stage ≥ 2(at-risk NASH patients) and also patients with fibrosis stage ≥ 3(advanced fibrosis) was compared with the diagnostic performance of the FIB-4 score, NAFLD fibrosis score, BARD score, APRI score and kPa measurements obtained from MRE by using ROC analysis. The new score can detect patients with fibrosis stage ≥ 2 with a higher diagnostic accuracy (AUROC 0.88, %95 CI 0.79 – 0.97) than other noninvasive tests and MRE, and also can detect advanced fibrosis with a strong diagnostic accuracy(AUROC 0.95, %95 CI 0.90 – 1.00) that is similar to other noninvasive tests and higher than MRE.