Table 2. Fibrosis scores appropriate for NAFLD [according to (16,19,21,32,49) and literature indicated in the right column].
| Score | Components | Risk of fibrosis | Literature |
|---|---|---|---|
| Serum tests | |||
| NFS, NAFLD fibrosis score | Serum glucose, platelet count, albumin, AST/ALT ratio; age, BMI, and diabetes status |
>0.676 (fibrosis), <−1.455 (no fibrosis) | Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846-54 |
| FIB-4 | Age, AST, platelet count, ALT | <1.45 (no fibrosis NPV 90%), >3.25 fibrosis (PPV 65%) | Sterling RK, Lissen E, Clumeck N, et. al. Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatology 2006;43:1317-25 |
| BARD | BMI, diabetes, AST/ALT ratio | 0–1: low risk, 2–4: high risk, NPV 97% | Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut 2008;57:1441-7 |
| Fibro-Test® commercially available | α2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, gamma glutamyl transpeptidase (GGT), age, gender | 0–1.0, 0 no fibrosis, 1.0 F4 fibrosis | Ratziu V, Massard J, Charlotte F, et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterology 2006;6:6. https://www.biopredictive.com/ |
| ELF® enhanced liver fibrosis test commercially available | Hyaluronic acid (HA), procollagen III amino-terminal peptide (PIIINP), and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1) | >10.51 advanced fibrosis | https://www.nice.org.uk/guidance/ng49/chapter/recommendations |
| Pro-C3® test commercially available | NASH biomarker synthesis of type III collagen, propeptide | Gloomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013;10:686-90. www.bms.com/researchers-and-partners/areas-of-focus.html | |
| CK18 M30 (M30-Apopto-sense®) commercially available | Caspase-cleaved CK18 fragments | <150 U/L healthy, >200 U/L elevated | Fitzpatrick E, Mitry RR, Quaglia A, et al. Serum levels of CK18 M30 and leptin are useful predictors of steatohepatitis and fibrosis in paediatric NAFLD. J Pediatr Gastroenterol Nutr 2010;51:500-6 |
| leucocyte telomere length (LTL) | Fibrosis in T2DM | Kim D, Li AA, Ahmed A. Leucocyte telomere shortening is associated with nonalcoholic fatty liver disease-related advanced fibrosis. Liver Int 2018;38:1839-48 | |
| Imaging methods | |||
| FibroScan®, transient hepatic elastography | Liver stiffness measurements | <7 kPa normal, <12 kPa severe fibrosis | Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003;29:1705-13 |
| Dynamic liver function test | |||
| LiMAx (liver maximum capacity) | Reflects cytochrome P450 1A2 activity | LiMAx values >315 ìg/kg/h are considered normal | Blüthner E, Pape UF, Stockmann M, et al. Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition-Results from the Prospective PN Liver Trial. Nutrients 2020:26:12 |