Pankaj Rajvanshi, MD1, Srikrishna Gurumurthy, 2 1Swedish Medical Center, Redmond, WA; 2Nikola Tesla STEM High School, Redmond, WA
Introduction: Up to 30% of individuals with non-alcoholic fatty liver disease (NAFLD) may be lean (BMI < 25 kg/m2, non-Asian race; < 23 kg/m2, Asian race) and are categorized as Lean NAFLD. Non-invasive fibrosis scores (NIFS) are recommended to screen for liver fibrosis in these patients. FIB-4 and NAFLD Fibrosis Score (NFS) have been shown to perform similarly to obese patients in Lean NAFLD in data from Asia. We examined performance characteristics of FIB-4, NFS, BARD score, and AST to platelet ratio index (APRI) in a large cohort of patients in the United States.
Methods: We obtained data from the NAFLD Adult database. A total number of 1073 patients had liver biopsy results available. We calculated the NIFS on all these patients and divided them into two groups, the Lean NAFLD group, and the Obese NAFLD group. Cut-off values for significant fibrosis, SF (>F2) were FIB-4 >1.3, APRI > 0.7, BARD score > 2, and NFS of >-1.455. Advanced fibrosis, AF (>F3) was assessed with FIB-4 >2.67, APRI > 1, NFS > 0.675, and Cirrhosis (F4) with a FIB-4 >3.48 or APRI > 1.5.
Results: Patient characteristics of this cohort have been previously published. 1031 patients with obese NAFLD and 42 lean NAFLD patients were included in our analysis. Among the Lean NAFLD group, 42 patients, 7 (16.7%) had T2DM, and 3 (7.1%) were non-Asian. In the obese NAFLD group, 1031 patients, 310 (30.0%) had T2DM, and 891 (86.4%) were non-Asian. The performance characteristics of NIFS are shown in Table 1.
The performance of FIB-4 in a large U.S. cohort showed better AUROC and Specificity (Sp) for SF (>F2) in Lean NAFLD, while performance of NFS and APRI were similar in the two groups. For prediction of AF (>F3), NFS had superior sensitivity (99.1%) and BARD score had better Sp (75.3%) in patients with Obese NAFLD. For prediction of cirrhosis (F4), all parameters were similar, but APRI had the significantly superior NPV (52.8%). The number of Asian patients was too small for a subgroup analysis.
Discussion: The performance of the non-invasive fibrosis scores in a cohort of U.S. patients is highly variable. There is a need for new prediction models for prediction of significant and advanced fibrosis in patients with Lean NAFLD.
Disclosures:
Pankaj Rajvanshi: AbbVie, Inc. – Speakers Bureau.
Srikrishna Gurumurthy indicated no relevant financial relationships.
Pankaj Rajvanshi, MD1, Srikrishna Gurumurthy, 2. P2437 - Performance Characteristics of Non-Invasive Fibrosis Scores in Lean Individuals with Non-Alcoholic Fatty Liver Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
