The combination of the enhanced liver fibrosis and FIB‐4 scores to determine significant fibrosis in patients with nonalcoholic fatty liver disease

Summary Background The presence of fibrosis in NAFLD is the most significant risk factor for adverse outcomes. We determined the cutoff scores of two non‐invasive te sts (NITs) to rule in and rule out significant fibrosis among NAFLD patients. Methods Clinical data and liver biopsies were used for NAFLD patients included in this analysis (2001–2020). The enhanced liver fibrosis (ELF) and FIB‐4 NITs were calculated. Liver biopsies were read by a single hematopathologist and scored by the NASH CRN criteria. Significant fibrosis was defined as stage F2–F4. Results There were 463 NAFLD patients included: 48 ± 13 years old, 31% male, 35% type 2 diabetes; 39% had significant fibrosis; mean ELF score was 9.0 ± 1.2, mean FIB‐4 score was 1.22 ± 1.05. Patients with significant fibrosis were older, more commonly male, had lower BMI but more components of metabolic syndrome, higher ELF and FIB‐4 ( p < 0.0001). The performance of the two NITs in identifying significant fibrosis was: AUC (95% CI) = 0.78 (0.74–0.82) for ELF, 0.79 (0.75–0.83) for FIB‐4. The combination of ELF score ≥9.8 and FIB‐4 ≥ 1.96 returned a positive predictive value of 95% which can reliably rule in significant fibrosis (sensitivity 22%, specificity >99%), while an ELF score ≤7.7 or FIB‐4 ≤ 0.30 had a negative predictive value of 95% ruling out significant fibrosis (sensitivity 98%, specificity 22%). Conclusions The combination of ELF and FIB‐4 may provide practitioners with easily obtained information to risk stratify patients with NAFLD who could be referred to specialists or for enrollment in clinical trials.