MAFLD (new concept for NAFLD) cut-off for FIB-4 - science article

[MINTVCX]

"Do we need a new cut-off for FIB-4 in the metabolic dysfunction-associated fatty liver disease era?"

"In conclusion, the diagnostic performance of FIB-4 in the MAFLD group was not different from that in the NAFLD group. However, it would be appropriate to lower the cut-off to 1.0 in order to reduce the rate of missed advanced fibrosis diagnoses."

journal-of-hepatology.eu/ar...

It is worth to indicate that advanced fibrosis is at least >=F3 (only F3 and F4). So Fib-4 is very good to rule out advanced fibrosis. Of course is not 100% but above 90% (high NPV). But it is not so good to confirm advanced fibrosis (lower PPV) amongst people with fatty liver (further tests are needed then).

Edit: Also not MAFLD but FIB-4:

"The role of fibrosis index FIB-4 in predicting liver fibrosis stage and clinical prognosis: A diagnostic or screening tool?"

"Conclusion

The role of FIB-4 in chronic liver disease and acute liver injury was not systematically described previously. FIB-4 served as a screening tool with high NPVs in ruling out fibrosis, so other methods like transient elastography or biopsy should be combined for intermediate or high risk.

(...)

In conclusion, FIB-4 has great potential in the diagnosis of liver fibrosis caused by viral hepatitis and NAFLD and was predictive in long-term or short-term prognosis."

sciencedirect.com/science/a...

About MAFLD:

"Metabolic associated fatty liver disease (MAFLD) is a new concept proposed in 2020 aiming to re-define fatty liver disease.[3],[4] As the diagnosis of MAFLD requires the presence of metabolic risk and does not require the exclusion of other liver disease, the clinical features of patients with MAFLD would be different from NAFLD"

"The diagnosis of MAFLD was based on the following criteria[4]: histologically evident hepatic steatosis with the presence of any of the following 3 conditions: BMI ≥23 kg/m2, type 2 diabetes mellitus, or evidence of metabolic dysregulation."

[Hidden]

Hi Mintvcx and thanks for posting. This is a subject which the clinicians are still debating - NAFLD or MAFLD?! Would be interesting to hear forum member's views on this. Trust10.

[kensimmons in reply to Hidden]

A reminder as always that I am not a doctor.

These researchers just took a low number that has been used to say "you can relax, you are healthy...95 percent chance you are in the clear if you have this number" and made it an even lower number and now are saying "you can relax, you are healthy....99 percent chance you are in the clear if you have this number".

A simple example would be a basic sports metaphor. If you are a normal professional basketball team and if your team gets the other team to end the game with a low score of let's say, 80 points, your good defensive play means that you will have a 95% chance that you will win the game. Now these researchers are taking it one step further and saying "And guess what we figured out? We see that if you make the team score even less, say, only 70 points you have a now have an even better - 99% instead of 95% - chance of winning the game".

Okay, thanks for nothing researchers. You gave us some information that anyone with common sense knew to be true to begin with!

Here is the calculator -

hepatitisc.uw.edu/page/clin...

This article is going to needlessly worry people. For anyone with hypochondria this does NOT mean you are sick if you get above the new 1.0 to 1.3 basis range - see the chart where it says PPV - PPV means "if you have this number this is the chance you are sick", it is the next to last number on the right - relax - with one exception all the PPVs are very low -

journal-of-hepatology.eu/ac...

And remember this measures something using the AST and ALT numbers that can sometimes go up and down by 50 percent day to day. Are they even reliable indicators?

clinlabnavigator.com/alanin....

Platelets fluctuate too - why are we using these indicators? Quote -

It is important that platelet counts not be done too often since the levels fluctuate, sometimes quite widely. One week the platelets may be 27, the next week 51, and the week after that 18 without any change in the person's treatment or bleeding.

itpsupport.org.uk/american/...

[MINTVCX in reply to kensimmons]

I think you are looking for 100% confidence which can never be established by any single test. Noninvasive tests like Fib-4 help to take further steps to make proper diagnosis and treatment. You cannot expect it will tell your status exactly. But it is very useful when you see it as a part of the whole picture (symptoms, imaging tests and many more).

[kensimmons in reply to MINTVCX]

I am not looking for 100 percent accuracy.

I just wanted people who have a tendency to see things in the worst light to realize that these results only show at what number can a small number of people say "I am in damn good shape".

Not "passing" the test in does not mean someone is sick. Most will be just fine even if they score above 1.0.

Of course, as you correctly said, no test is 100 percent accurate or determinative and all of the tests and all of the numbers are just part of a big picture.

[Dd4560]

So someone who scores a fib-4 of below 1.0, like lets say they score a 0.5, does that mean they have a 99% chance of not having advanced fibrosis? Do I understand that correctly?

[MINTVCX in reply to Dd4560]

According to this article between 96.5 to 99.5 (depending on prevalence). Other articles say around above 90% (0.9) PPV. But you can still have F2 with more probability. Also for example is not so good for AiH:

"Conclusions: TE performs well to stage liver fibrosis in patients with AIH, compared with other laboratory non-invasive indexes. Nevertheless, diagnostic accuracy of APRI and FIB-4 is poor."

pubmed.ncbi.nlm.nih.gov/304...

But if only fatty liver is involved is pretty good to rule out advanced fibrosis. But never 100%. This study was done amongst people with " histologically evident hepatic steatosis" so not sure if NPV (ability to rule out F3-F4) will be so good for other liver dieases like mentioned Aih, alcohol and so on.

BTW some new article about the subject:

"The role of fibrosis index FIB-4 in predicting liver fibrosis stage and clinical prognosis: A diagnostic or screening tool?"

Conclusion

The role of FIB-4 in chronic liver disease and acute liver injury was not systematically described previously. FIB-4 served as a screening tool with high NPVs in ruling out fibrosis, so other methods like transient elastography or biopsy should be combined for intermediate or high risk.(

(...)

In conclusion, FIB-4 has great potential in the diagnosis of liver fibrosis caused by viral hepatitis and NAFLD and was predictive in long-term or short-term prognosis.

sciencedirect.com/science/a...

[kensimmons in reply to Dd4560]

More or less, yes Dd4560, that is (more or less) what the means. Congratulations. And of course, I am not a doctor, so check with one, but I am confident that is what he will tell you.