More accurate detection of liver fibrosis can be achieved with simple scoring tools by looking at changes in measures rather than one-off values, Queensland clinicians have shown.

Commonly used noninvasive tests such as the fibrosis-4 (FIB-4) and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) suffer from poor sensitivity  – as low as 44% – when single measures are used to detect advanced fibrosis in people with NAFLD, according to Dr Benjamin McKillen and colleagues at the Centre for Liver Disease Research at the University of Queensland Translational Research Institute.

Another problem with the tools is that many patients have scores in the indeterminate range, and yet up to 31% of these people have advanced fibrosis, they note in the Journal of Clinical Gastroenterology.

However in a review of annual measurements from the two screening tools taken over a four year period they found that the changes over time were much better at predicting advanced fibrosis.

In a pilot study involving 72 adults with NAFLD who underwent liver biopsy at the Princess Alexandra Hospital in Brisbane they found that the changes in FIB-4 Score and NFS in the preceding four year period had a better diagnostic performance than a static score, with misclassification errors of 17% and <19% vs >40%, respectively.

For the FIB-4 Score there was a 4.27-fold increase in the odds of having advanced fibrosis for every 1 U increase in score over four years.  It correctly classified fibrosis status in 59 of 72 patients, with a sensitivity and specificity of  82% for both, whereas the sensitivity was only 21% for the single FIB-4 Score. The area under the curve performance was 0.81.

A similar significant relationship was seen between 4-year NFS change and fibrosis status, (area under the curve = 0.82), where for every 1 U increase in NFS over 4 years there was a 4.12-fold increase in odds of having advanced fibrosis.

The 4-year models for FIB-4 Score and NFS also correctly predicted fibrosis status in 80% and 83% of patients with intermediate scores, respectively.

The study investigators said the four year changes in FIB-4 Score and NFS showed potential to fill the unmet need for a robust measure that can accurately identify advanced fibrosis in high-risk people with NAFLD.

“Our data suggest that refinement of currently available simple scores can improve prediction of liver fibrosis severity, and may reduce the need for more costly confirmatory second-line tests, such as transient elastography and the Enhanced Liver Fibrosis Test, that may not be as readily available in the wider community,” they concluded.