Introduction Simple non-invasive fibrosis scores, such as the FIB-4 and NAFLD fibrosis scores (NFS), are now widely used to identify/exclude advanced fibrosis in patients with NAFLD. Use of these scores in primary care provides a simple objective method to identify patients who need further investigation for advanced fibrosis. Few older patients (≥ 65 years) were included in previous studies, but older patients represent a large proportion of patients with NAFLD in the community. The aim of this study was to assess the performance of simple non-invasive fibrosis tests in older patients (≥65 years old) with biopsy-proven NAFLD.
Method Patients with biopsy proven NAFLD were recruited from 4 specialist fatty liver clinics. The diagnostic performance of the AST/ALT ratio, FIB-4 and NFS were assessed using liver biopsy as the standard.
Results From a total of 634 patients, 76 were ≥65 years (mean age 69 ± 3 years, 35% male, 58% diabetic). 60 (79%) of the older patients had steatohepatitis and 30 (39%) had advanced fibrosis (stage 3–4). In older patients the AUROCs for a diagnosis of advanced fibrosis were 0.73, 0.81 and 0.81 for the AST/ALT ratio, FIB-4 and NFS respectively, which was similar to younger patients (0.69, 0.80 and 0.82 respectively). However the specificity for advanced fibrosis using the FIB-4 and NFS was much lower in the older patients than younger patients (FIB-4 35% vs 79%; NFS 20% vs 66%), leading to a high false positive rate. New cut-offs for older patients were derived to improve the specificity to 70% and did not adversely affect the sensitivity (FIB-4 2.0, sensitivity 77%; NFS 0.12, sensitivity 80%).
Conclusion The diagnostic accuracy for advanced fibrosis using the NFS and FIB-4 score was similar in older and younger patients. However, the specificity for advanced fibrosis was low in older patients (≥ 65 years), resulting in a high false positive rate, which may result in patients undergoing unnecessary further investigations. Adoption of our new cut-offs could reduce the proportion of older patients being referred from primary care for further investigation.
Disclosure of interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.