Diagnostic Performance of Fibrosis-4 Index, Nonalcoholic Fatty Liver Disease Fibrosis Score, AST-To-Platelet Ratio Index, and BARD Score Among Young and Older Adults for the Diagnosis of Advanced MASLD Fibrosis: A Retrospective Cohort Study.

Aims: This study aims to compare the diagnostic performance and accuracy of non-invasive fibrosis scoring tools, including the Fibrosis-4 index (Fib-4), Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS), AST-to-Platelet Ratio Index (APRI), and BARD score among patients with biopsy-proven MASLD or MASH, to either diagnose or exclude advanced fibrosis. Methods and Results: A retrospective cohort of patients with biopsy-proven MASLD or MASH was analyzed. Inclusion criteria for the study included patients over the age of 18, liver biopsy-proven MASLD or MASH, and availability of laboratory findings prior to the biopsy to perform calculations for the non-invasive liver fibrosis scoring tools. Patients were excluded based on a history of alcohol use and evidence of another or coexisting cause of chronic liver disease based on laboratory or pathology findings. Data were collected on patient demographics, comorbidities, and liver biopsy findings. The stage of fibrosis was determined using the Metavir Scoring System (F0-F4) categorized into mild to moderate (score: 1-2) and advanced fibrosis (score: 3-4). The statistical analysis of the four non-invasive fibrosis scoring tools in this study resulted in a higher negative predictive value for all patients, particularly in the young adult population. There was significant variability and limitations regarding sensitivity, specificity, and AUROC for all four scores. Conclusions: The study suggests that the Fib-4, NFS, APRI, and BARD scores are valuable biomarkers for excluding advanced fibrosis in patients with MASLD or MASH. These four biomarkers are precluded as confirmatory tests; thus, further research and risk stratification with other non-invasive scoring modalities or imaging are needed.