Accuracy of Noninvasive Scoring Systems in Assessing Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Sangsoo Han,
Miyoung Choi,
Bora Lee,
Hye-Won Lee,
Seong Hee Kang,
Yuri Cho,
Sang Bong Ahn,
Do Seon Song,
Dae Won Jun,
Jieun Lee,
Jeong-Ju Yoo
Affiliations
Sangsoo Han
Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
Miyoung Choi
Clinical Evidence Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
Bora Lee
Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
Hye-Won Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Seong Hee Kang
Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
Yuri Cho
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
Sang Bong Ahn
Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
Do Seon Song
Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
Dae Won Jun
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
Jieun Lee
Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
Jeong-Ju Yoo
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
Background/Aims: Several noninvasive scoring systems have been developed to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). We examined the diagnostic accuracy of the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS) in patients with biopsy-proven NAFLD.Methods: For this meta-analysis, various databases including PubMed (MEDLINE), EMBASE, OVID Medline and the Cochrane Library were systematically searched. After the acquired abstracts were reviewed by two investigators, manuscripts were chosen for a full-text examination.Results: Thirty-six studies evaluating biopsy-proven NAFLD were selected for meta-analysis. A total of 14,992 patients were analyzed. The lower cutoff sensitivity of the FIB-4 score predicting histological fibrosis stage 3 or more (≥F3) was 69%, with specificity of 64%, positive likelihood ratio (LR+) of 1.96, and negative likelihood ratio (LR–) of 0.47. The low baseline sensitivity of the NFS score predicting ≥F3 was 70%, with a specificity of 61%, LR+ of 1.83, and LR– of 0.48. The area under the receiver operating characteristic curve (AUC) values of the FIB-4 score predicting ≥F3 and ≥F2 were 76% and 68%, respectively. The AUC values of the NFS score predicting ≥F3 and ≥F2 were 74% and 60%, respectively.Conclusions: The FIB-4 or NFS test can be used to predict the degree of liver fibrosis in NAFLD, and the diagnostic accuracy resulted as relatively high in fibrosis stages of F3 or higher.
