Development and Validation of a Simple NAFLD Clinical Scoring System for Identifying Patients Without Advanced Disease
Stephen Harrison MD1*, Dana Oliver 2, Hays L. Arnold MD1, Sudhanshu Gogia MD2 and Brent A. Neuschwander-Tetri MD2
1 Brooke Army Medical Center, United States
2 Saint Louis University, United States
* To whom correspondence should be addressed. E-mail: stephen.harrison{at}amedd.army.mil.
Accepted 21 March 2008
 | Abstract |
|---|
Background: Clinical predictors of advanced nonalcoholic liver disease (NAFLD) are needed to guide diagnostic evaluation and treatment.
Methods: To better understand the demographics of NAFLD and risk factors for advanced disease, this study analyzed 827 NAFLD patients at two geographically separate tertiary medical centers.
Results: The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m2; 3% had a normal BMI. Common comorbidities included hypertension (60%) and diabetes (35%); insulin resistance was present in 91% and advanced fibrosis in 24% of patients. When comparing patients with no fibrosis or mild fibrosis to those with advanced fibrosis, BMI 
28 kg/m2, age > 50, AST/ALT ratio (AAR) 0.8, QUICKI score <0.294 (equivalent to HOMA > 6.2) and the presence of DM were individually associated by univariate analysis with odds ratios (OR) of 2.4 for advanced fibrosis. Based on the results of a stepwise forced entry logistic regression analysis, three of these variables were combined in a weighted sum (BMI 28 = 1 point, AAR of ¡
0.8 = 2 points, DM = 1 point) to form an easily calculated composite score for predicting advanced fibrosis called the BARD score. A score of 2-4 was associated with an OR for advanced fibrosis of 17 (CI:9.2-31.9) and a negative predictive value of 9496%.
Conclusions: Insulin resistance and its co-morbidities are often present in patients with NAFLD. An easily calculated score based on readily available clinical data can reliable reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.
