Correlation between non-invasive measures of fibrosis and FibroScan: An update on local experience

ABSTRACT

Background and Aim: The correlation between non-invasive fibrosis scores and histological liver fibrosis is well established. As the availability of FibroScan is limited in geographically isolated settings and those impacted by coronavirus disease 2019 (COVID-19), we aimed to demonstrate a correlation between FibroScan median liver stiffness readings of patients with metabolic-associated fatty liver disease (MAFLD) with aspartate aminotransferase (AST) to platelet ratio index (APRI), Fibrosis-4 (FIB-4) score, and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS). Methods:We conducted a retrospective analysis over 2 years of patients referred to the hepatology service by primary care physicians with deranged liver function test results. Data were obtained from routine clinical investigations in electronic medical records at a single Australian tertiary referral center. Data collected included FibroScan liver stiffness measurements, age, body mass index, glycated hemoglobin level, albumin level, platelet count, AST level, and alanine aminotransferase (ALT) level. The APRI, FIB-4, and NFS scores were calculated. Results: We identified 65 patients, all of whom proceeded to FibroScan and exclusion of causes other than MAFLD. Of the 65 patients, we found correlation between FibroScan and all non-invasive scores. However, as expected, there was an indirect relationship only with multiple outliers beyond the commonly used cut-offs for excluding advanced fibrosis (APRI < 0.5, FIB-4 < 1.45, NFS < -1.45). Of the 48 patients with an APRI score < 0.5, 41 (85.4%) had a FibroScan result of <8.0 kPa. Of the 54 patients with a FIB-4 score < 1.45, 47 (87%) had a FibroScan result of <8 kPa. Of the 43 patients with an NFS score < -1.454, 41 (95%) had a FibroScan result of <8 kPa (Fig. 1). Conclusion: Use of non-invasive measures of fibrosis is accurate for excluding advanced fibrosis in the population with MAFLD. Individual previously published cut-off values all correlate well with a FibroScan reading of <8 kPa;so much so that, when used together, they may be relied upon when FibroScan is unavailable. This has obvious indications in the Australian setting with regional and remote communities that have limited access to FibroScan. This is of particular value in helping to avoid hospital attendance amid the COVID-19 pandemic and is also of value in risk stratification in primary care.