SynthesisLiver international : official journal of the International Association for the Study of the Liver2021
Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review.
Synthesis in Liver international : official journal of the International Association for the Study of the Liver, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 228 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
228 citing papers in PubMed, 3 syntheses or guidelines pooled it, 350 citations in OpenAlex.
- Short-Term Impact of Endoscopic Gastric Remodeling in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis.Obesity surgery · 2026Pooled it
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography.Journal of hepatology · 2023Pooled it
- Patatin-like phosphatase domain-containing 3 genotype and quality of dietary fat modify the liver adiposity in men.European journal of nutrition · 2026Trial
- Therapeutic Effects of a WeChat Mini-Program on Metabolic Dysfunction-Associated Fatty Liver Disease: Randomized Controlled Trial.Journal of medical Internet research · 2026Trial
- A novel model for detecting advanced fibrosis in patients with nonalcoholic fatty liver disease.Diabetes/metabolism research and reviews · 2022Trial
- Screening and diagnosis of liver disease in diabetes: a guide and evidence-based assessment.Diabetologia · 2026Review
- pFIB scores for paediatric MASLD fibrosis are associated with risk of youth-onset type 2 diabetes in children with obesity.Diabetologia · 2026Article
- Liver steatosis and cognitive performance in aging: A pilot cross-sectional study.Clinical imaging · 2026Article
- Discovery of Epidermal Growth Factor-Like 7 as a Potential Non-Invasive Biomarker for Fibrosis and Mortality Risk in MASLD.Clinical and translational science · 2026Article
- European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) steatotic liver disease special interest group position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction-associated steatotic liver disease.Journal of pediatric gastroenterology and nutrition · 2026Article
- Steatotic liver disease: non-invasive assessment and biomarkers across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatotic liver disease with moderate alcohol consumption and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- Emerging Indices Outperform Traditional Fibrosis Scores in Young Metabolic Dysfunction-Associated Steatotic Liver Disease Across Divergent Screening Goals.Journal of gastroenterology and hepatology · 2026Article
- Predictive modeling and clinical decision tools for risk stratification in steatotic liver disease.Clinical and molecular hepatology · 2026Review
- Liver fibrosis risk: a silent threat in type 1 diabetes mellitus.Journal of endocrinological investigation · 2026Article
- Impact of sleeve gastrectomy on the course of metabolic associated fatty liver disease.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Observational
- Global multicenter validation of noninvasive fibrosis assessment pathways in MetALD and ALD.Hepatology communications · 2026Article
- Serum SOS1 as a prognostic biomarker and therapeutic target for progressive liver disease.iScience · 2026Article
- Article
- Interactive Roles of Metabolic Dysfunction-Associated Steatotic Liver Disease and Nutritional Status in the Prognosis of Patients With Hepatocellular Carcinoma After Surgical Resection.The Kaohsiung journal of medical sciences · 2026Article
168 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsFibrosis is the strongest predictor for long-term clinical outcomes among patients with non-alcoholic fatty liver disease (NAFLD). There is growing interest in employing non-invasive methods for risk stratification based on prognosis. FIB-4, NFS and APRI are models commonly used for detecting fibrosis among NAFLD patients. We aimed to synthesize existing literature on the ability of these models in prognosticating NAFLD-related events.
methodsA sensitive search was conducted in two medical databases to retrieve studies evaluating the prognostic accuracy of FIB-4, NFS and APRI among NAFLD patients. Target events were change in fibrosis, liver-related event and mortality. Two reviewers independently performed reference screening, data extraction and quality assessment (QUAPAS tool).
resultsA total of 13 studies (FIB-4:12, NFS: 11, APRI: 10), published between 2013 and 2019, were retrieved. All studies were conducted in a secondary or tertiary care setting, with follow-up ranging from 1 to 20 years. All three markers showed consistently good prognostication of liver-related events (AUC from 0.69 to 0.92). For mortality, FIB-4 (AUC of 0.67-0.82) and NFS (AUC of 0.70-0.83) outperformed APRI (AUC of 0.52-0.73) in all studies. All markers had inconsistent performance for predicting change in fibrosis stage.
conclusionsFIB-4, NFS, and APRI have demonstrated ability to risk stratify patients for liver-related morbidity and mortality, with comparable performance to a liver biopsy, although more head-to-head studies are needed to validate this. More refined models to prognosticate NAFLD-events may further enhance performance and clinical utility of non-invasive markers.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.