Fibrosis testsγ
| Investigation panel name | Commercial? | Formula and variables | AUROC | Sensitivity (Se) and specificity (Sp) | Comments | Primary reference |
|---|---|---|---|---|---|---|
| AAR | No | AST (IU/L)/ALT (IU/L) | 0.8357 | Threshold >1 in HCV cirrhosis: Se 0.53, Sp 1.0, PPV 1.0, NPV 0.81 | Validated in NAFLD, threshold >0.8: Se 0.74, Sp 0.78, PPV 0.44, NPV 0.9357 | 123 |
| APRI | No | AST (IU/L)/(ULN)/platelet count (×109/L)×100 | 0.564124 | Threshold >1: AUROC 0.67, Se 0.27, Sp 0.89, PPV 0.37, NPV 0.84 | Validated in another cohort: AUROC 0.85 with optimal cut-off 0.98, Se 0.75, Sp 86%, PPV 0.54, NPV 0.93125 | 57 |
| BAAT | No | Count of number of features present:
| 0.86 | Threshold 4 parameters: Se 0.14, Sp 100 (PPV 100%, NPV 73%) | 126 | |
| BARD | No | Weighted sum of BMI ≥ 28=1 point, AST/ALT ratio ≥ 0.8=2 points, T2DM=1 point | 0.81 | Score ≥2, Se 0.91, Sp 0.66, OR for advance fibrosis 17, NPV 0.96 | 127 | |
| FIB-4 | No | Age×AST (IU/L)/platelet count (×109/L)×√ ALT (IU/L) | Threshold >2.67: Se 0.33, Sp 0.98, PPV 0.80, NPV 0.83 for advanced fibrosis Threshold <1.30: Se 0.74, Sp 0.71, PPV 0.43, NPV 0.90 for absence of advanced fibrosis | 128 | ||
| Fibrometer | Yes | Patented algorithm combining age, body weight, glucose, AST, ALT, ferritin and platelet count | 0.94 for > F2 fibrosis | Threshold > 0.715: Se 0.79, Sp 0.96 | 129 | |
| Fibrotest | Yes | Patented algorithm including total bilirubin, GGT, A2M, ApoA1 and haptoglobin, corrected for age and gender | ≥F2 Fibrosis 0.81 | Threshold <0.30: Se 0.77, Sp 0.77, NPV 0.90 Threshold >0.70: Se 0.15, Sp 0.98, PPV 0.98 | 130 | |
| Gholam's Model | No | 2.45 * ln (ALT)—38.55 (1/HbA1c)+5 | 0.822 | Threshold >6.6: Se 0.76, Sp 0.66 | 93 | |
| NAFLD Diagnostic Panel | Yes | Patented algorithm for NASH related advanced fibrosis model including T2DM, triglycerides, TIMP1 and AST | 0.81 | 95 | ||
| NAFLD Fibrosis Score | No | −1.675+0.037×age (years)+0.094×BMI (kg/m2)+1.13×IFG or diabetes (yes=1, no=0)+0.99×AST/ALT ratio—0.013×platelet (×109/L)—0.66×albumin (g/dL) | 0.82–0.88 | Threshold >0.676 for presence of significant fibrosis: Se 0.51, Sp 0.98, PPV 0.90, NPV 0.85 Threshold <−1.455 for absence of significant fibrosis: Se 0.82, Sp 0.77, PPV 0.56, NPV 0.93 | 131 | |
| Original European Liver Fibrosis Score (OELF) | Yes | −6.38—(ln(age)*0.14)+(ln(HA)*0.616)+(ln(PIIINP)*0.586)+(ln(TIMP1)*0.472) | 0.87 | Threshold >0.462: to exclude significant fibrosis, Se 0.78, Sp 0.98, PPV 0.87, NPV 0.96 | 132 | |
| ‘Simplified’ ELF | Yes | −7.412+(ln(HA)*0.681)+(ln(PIIINP)*0.775)+(ln(TIMP1)*0.494) | 0.90 for ≥F3 fibrosis, 0.82 for moderate fibrosis, 0.76 for no fibrosis | Threshold >0.3576: Se 0.80, Sp 90%, PPV 0.71, NPV 0.94 | 56 |
A2M, α2-macroglobulin; AAR, AST to ALT ratio; ALT, alanine aminotransferase; ApoA1, apolipoprotein A-I; APRI, AST to Platelet Ratio Index; AST, aspartate aminotransferase; AUROC, area under the receiver operating characteristic curve; BMI, body mass index; ELF, Enhanced Liver Fibrosis test; HA, hyaluronic acid; HCV, hepatitis C virus; IFG, impaired fasting glucose; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; NPV, negative predictive value; PIIINP, procollagen III; PPV, positive predictive value; Se, sensitivity; Sp, specificity; T2DM, type 2 diabetes mellitus; TG, triglycerides; TIMP1, tissue inhibitor of matrix metalloproteinase 1; ULN, upper limit of normal.