Comparison of blood tests for liver fibrosis specific or not to NAFLD

Background/Aims:To compare blood tests of liver fibrosis specific for NAFLD: the FibroMeter NAFLD and the NAFLD fibrosis score (NFSA) with a non-specific test, APRI. Methods:Two hundred and thirty-five NAFLD patients with liver Metavir staging and blood markers from two independent centres were randomly assigned to a test (n = 121) or a validation population (n = 114). Results: The highest accuracy - 91% - for significant fibrosis was obtained with the FibroMeter whose (i) AUROC (0.943) was significantly higher than those of NFSA (0.884, p = 0.008) and APRI (0.866, p < 10(-3); P = 0.309 vs NFSA) in the whole population, and (ii) misclassification rate (9%) was significantly lower than those of NFSA (14%), p = 0.04) and APRI (16%, p = 0.002) and did not vary according to centre (14 vs 7%, p = 0.07), unlike those of NFSA (25 vs 9%, p = 0.001) and APRI (29 vs 11%, P < 10(-3)). By using thresholds of 90% predictive values, liver biopsy could have been avoided in most patients: FibroMeter: 97.4% vs NFSA: 86.8% (p < 10(-3)) and APRL 80.0% (p < 10(-3)). A new classification provided three reliable diagnosis intervals: F0/1, F0/1/2, F2/3/4 with 91.4%, accuracy for FibroMeter, avoiding biopsy in all patients. Conclusions: FibroMeter NAFLD had high performance and provided reliable diagnosis for significant fibrosis, significantly outperforming NFSA and APRI. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.