ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2009
Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 831 papers, 2 of them syntheses that pooled it.
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831 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Short-Term Impact of Endoscopic Gastric Remodeling in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis.Obesity surgery · 2026Pooled it
- Association between the Fibrosis-4 index and stroke and related outcomes: a meta-analysis.Frontiers in neurology · 2026Pooled it
- Trial
- Semaglutide on liver fibrosis and heart outcomes in patients at high risk of liver fibrosis: a prespecified analysis of the SELECT randomized trial.Nature medicine · 2026 · on this mapTrial
- HTD1801 demonstrates promising potential for histologic improvements in metabolic dysfunction-associated steatohepatitis in both a preclinical and phase 2 study.Clinical and molecular hepatology · 2025Trial
- Hepatobiliary phase radiomics for identifying subclinical liver dysfunction in compensated chronic liver disease: development and external validation.Abdominal radiology (New York) · 2026Article
- Postoperative FIB-4 Trajectories by Biopsy-Confirmed Fibrosis Stage After Sleeve Gastrectomy: An Exploratory Biopsy-Based Cohort Study.Obesity surgery · 2026Article
- Early thyroid-stimulating hormone dynamics predict outcomes in advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab.Surgery today · 2026Article
- Metabolic Dysfunction-Associated Steatotic Disease and Genetic Risk in Germany-An Observational Real-World Cohort Study.United European gastroenterology journal · 2026Observational
- Risk of Hepatocellular Carcinoma or Hepatic Decompensation Associated With Steatotic Liver Disease in People With and Without HIV.Open forum infectious diseases · 2026Article
- Article
- Discrepancy between self-perceived dietary habits and objective clinical risk of liver fibrosis: A cross-sectional study of Japanese health checkup participants.Asia Pacific journal of clinical nutrition · 2026Article
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- Impact of bariatric surgery on alcohol-use disorder and alcohol-related liver disease: A retrospective study.Addiction (Abingdon, England) · 2026Article
- Association between statins and chronic liver disease progression: A retrospective cohort study.Clinics and research in hepatology and gastroenterology · 2026Article
- Steatotic Liver Disease Risk Scores to Predict Cirrhosis and Hepatocellular Carcinoma.JAMA internal medicine · 2026Article
- Differential Cancer Risks and Noninvasive Predictors in MASLD, MetALD, and ALD: A Longitudinal Analysis.Gut and liver · 2026Article
- Profiles and Prognostic Value of a Non-Invasive Liver Fibrosis Marker in Patients With Acute and Chronic Coronary Syndrome: Insights From the CLIDAS-PCI.Circulation reports · 2026Article
- Noninvasive Detection of Clinically Significant Fibrosis in Biopsy-Proven MASLD: A Retrospective Cross-Sectional Diagnostic Accuracy Study.Medicina (Kaunas, Lithuania) · 2026Article
- Factors Affecting Temporal Changes in Ablated Liver Volume After Radiofrequency Ablation for Hepatocellular Carcinoma Evaluated by Three-Dimensional Volumetric Computed Tomography.Tomography (Ann Arbor, Mich.) · 2026Article
771 more citing papers are in PubMed but not listed here.
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7 authors.
Funding
Abstract
BACKGROUND &
aimsThere is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the performance of the FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) with 6 other non-invasive markers of fibrosis in patients with NAFLD.
methodsUsing a nation-wide database of 541 adults with NAFLD, jackknife-validated areas under receiver operating characteristic curves (AUROC) of FIB4 and 7 other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis.
resultsThe median FIB4 score was 1.11 (interquartile range = 0.74-1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% confidence interval [CI], 0.758-0.847), which was higher than that of the NAFLD fibrosis score (0.768; 95% CI, 0.720-0.816; P = .09), Goteburg University Cirrhosis Index (0.743; 95% CI, 0.695-0.791; P < .01), AST:ALT ratio (0.742; 95% CI, 0.690-0.794; P < .015), AST:platelet ratio index (0.730; 95% CI, 0.681-0.779; P < .001), AST:platelet ratio (0.720; 95% CI, 0.669-0.770; P < .001), body mass index, AST:ALT, diabetes (BARD) score (0.70; P < .001), or cirrhosis discriminant score (0.666; 95% CI, 0.614-0.718; P < .001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity in identifying advanced fibrosis was only 50% (95% CI, 46-55). A FIB4 > or = 2.67 had an 80% positive predictive value and a FIB4 index < or = 1.30 had a 90% negative predictive value.
conclusionsThe FIB4 index is superior to 7 other noninvasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better noninvasive markers.
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