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Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease
  1. S A Harrison1,
  2. D Oliver2,
  3. H L Arnold1,
  4. S Gogia2,
  5. B A Neuschwander-Tetri2,3,4
  1. 1
    Division of Gastroenterology and Hepatology, Brooke Army Medical Center, San Antonio, USA
  2. 2
    Department of Internal Medicine, Saint Louis University, St Louis, USA
  3. 3
    Saint Louis University Liver Center, St Louis, USA
  4. 4
    Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, USA
  1. Dr S A Harrison, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA; Stephen.Harrison{at}


Background: Clinical predictors of advanced non-alcoholic 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 analysed 827 patients with NAFLD at two geographically separate tertiary medical centres.

Results: The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m2; 3% had a normal BMI. Common co-morbidities 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 years, and aspartate transaminase/alanine aminotransferase (AST/ALT) ratio ⩾0.8, a quantitative assessment check index (QUICKI) score <0.294 (equivalent to homeostatasis model assessment (HOMA) >6.2) and the presence of diabetes mellitus (DM) were individually associated by univariate analysis with odds ratios (ORs) of ⩾2.4 for advanced fibrosis. Based on the results of forced entry logistic regression analysis, three 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 (confidence interval 9.2 to 31.9) and a negative predictive value of 96%.

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 reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.

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  • See Commentary, p 1441

  • Competing interests: None.

  • Ethics approval: This study was approved by both the Brooke Army Medical Center and Saint Louis University Institutional Review Boards in June 2005 and December 2002, respectively.

  • The opinion or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the view of the US Department of the Army or the US Department of Defense.

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