Comparison of non-invasive scores for the evaluation of liver fibrosis in subjects with metabolic dysfunction-associated fatty liver disease (MAFLD)

Abstract

Introduction and Objectives: Metabolic-associated fatty liver disease (MAFLD) poses a significant risk for progression to advanced liver diseases, underscoring the need for early detection. This study aims to assess and compare the diagnostic efficacy of non-invasive markers (APRI, FIB-4, Hepamet, and NAFLD Score (NFS) in detecting hepatic fibrosis among MAFLD patients. Materials and Patients: A retrospective examination was performed on adults with MAFLD who had undergone transient liver elastography. Hepatic fibrosis was identified at a cut-off point of ≥8 kPa. APRI, FIB-4, Hepamet, and NFS scores were evaluated with cut-off points determined via the Youden index. Receiver Operating Characteristic (ROC) curves and their areas were computed. All participants provided informed consent. Results: Our cohort consisted of 150 MAFLD patients, the median age of 55 years (48-65), comprising 66.2% (129) females and 33.88% (66) males. The median BMI was 32.1 (28.8-35.6), kPa was 5.6 (4.6-7.8), and CAP was 310 (280-341). Hepatic fibrosis was evident in 24.7% (37) of the participants. Among the evaluated scores, APRI exhibited superior diagnostic performance, achieving an area under the curve of 0.72, followed by FIB-4 (0.66), Hepamet (0.64), and NFS (0.62). The cut-off points of 0.50 for APRI, 1.65 for FIB-4, 0.05 for Hepamet, and -0.75 for NFS yielded sensitivities of 86%, 82%, 86%, and 81%, respectively (Fig 1). Conclusions: Non-invasive scoring systems, notably APRI, demonstrate valuable potential in evaluating hepatic fibrosis among Mexican MAFLD patients. Utilization of adjusted cut-off points enhances test efficiency, thereby facilitating early detection of individuals at greater risk of disease progression.