Abstract:

Objective Nowadays, the incidence of non-alcoholic fatty liver and steatohepatitis (NASH) is increasing and early diagnosis is of great importance. In this study, we investigated the optimal predictive value of Fibrosis-4 (FIB-4), Aspartate Aminotransferase to Platelet Ratio (APRI) and AST/ALT Ratio in predicting liver fibrosis in NASH patients undergoing liver biopsy. Methods Patients with NASH who underwent liver biopsy were included in the study. Biopsy results of all patients were evaluated histopathologically and grade of fibrosis was graded. In addition, FIB-4, APRI and AST/ALT scores were calculated and compared with biopsy findings in these patients. Results A total of 88 patients were included in the study. Of these patients 51 (58%) were female and the mean age was 52.7 ± 9.5. According to biopsy results, NASH was detected in 79 (89.8%) and NAFLD in 9 (10.2%) of the patients. The cut-off value less than 0.47 for APRI score and <0.88 for FIB-4 score showed the best discriminatory power in exclusion of liver fibrosis. Likewise, the cut-off value greater than 0.68 for APRI score and > 2.16 for FIB-4 score showed the highest predictive value in predicting advanced fibrosis. AST/ALT ratio had no diagnostic value. Conclusion FIB-4 and APRI scores play an important role in the prediction of fibrosis in NASH patients, but the AST/ALT ratio is not sufficient. On the other hand, although the guidelines recommend using these scoring systems as a screening tool, there is no clarity as to the appropriate ideal cut-off values. At this point, FIB-4 score stands out with high sensitivity and specificity especially in the prediction of severe fibrosis.

Keywords: