Diagnostic accuracy of predictive indices for assessing liver steatosis and fibrosis as compared to transient elastography in patients with non-alcoholic fatty liver disease

Introduction. Non-alcoholic fatty liver disease (NAFLD) is a global public health challenge. Study data show that all-cause mortality rates increase significantly with liver fibrosis F ≥ 2; therefore, predictive indices (PI) are critical for the primary diagnosis of liver fibrosis and steatosis.

Aim. To assess the diagnostic accuracy of steatosis (FLI, ST) and liver fibrosis (FIB-4, APRI, NFS) PI for detecting liver fibrosis and steatosis as compared with transient elastography (TE) in patients with NAFLD.

Materials and methods. A total of 142 patients with NAFLD were included in the study. The computation of the above PI, TE-CAP was performed for all patients. The diagnostic accuracy of liver fibrosis and steatosis PI was compared with TE using a respondent-driven sampling. All patients underwent hand grip strength (HGS) measurement using a hand dynamometer.

Results. The FIB-4 (cut-off point > 1.94) showed AUC = 0.643, a sensitivity of 34.78% and specificity of 90.62 for differentiation between severe LF and cirrhosis (F3-F4). The APRI (cut-off point > 0.44) showed AUC = 0.615, a sensitivity of 54.35%, and specificity of 67.71 for differentiation between severe LF and cirrhosis (F3-F4). The NFS (cut-off point > 26.38) showed AUC = 0.681, a sensitivity of 58.7% and specificity of 79.1 for differentiation between severe LF and cirrhosis (F3-F4). The ST (cut-off point > 0.054) showed AUC = 0.713, a sensitivity of 45.63% and specificity of 87.18 for differentiation of severe liver steatosis (S2-S3). For HGS, a significant inverse correlation between HGS, based on hand dynamometer values, and the quantitative indicator of liver parenchyma density, based on TE (kPa) values, was found (r = -0.2879, p = 0.0005).

Conclusions. The FIB-4 and NFS indices showed the highest diagnostic accuracy for detecting severe AF and cirrhosis (F3-F4). The FLI and ST indices demonstrated the significant diagnostic accuracy for detecting severe liver steatosis (S2-S3). HGS can be used as an additional non-invasive method for the differentiation of patients with severe fibrosis and cirrhosis (F3-F4).

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