Concordance between indirect fibrosis and steatosis indices and their predictors in subjects with overweight/obesity

Background: The non-invasive assessment of steatosis/fibrosis tried to overcome some of peri-procedural risk of liver biopsy; for this, several indices of steatosis and fibrosis in liver have been proposed.

Aim: To evaluate concordance of non-invasive fibrosis and steatosis indices in a large population of adult subjects at risk of NAFLD, and how obesity and its physio-pathological features may interact with steatosis/fibrosis indexes and related biomarkers of cardio-metabolic risk.

Methods: Indices of steatosis (fatty liver index-FLI), NAFLD liver fat score-NLFS)) and fibrosis (Fibrosis 4 (FIB-4), BARD, BAAT and FORN) were calculated in 1145 outpatients with overweight or obesity at risk for T2D and NAFLD. Indices were correlated with clinical variables.

Results: Concordance between tests occurred in 81% of the overall values between FLI and NLFS, but was lower when comparing the other fibrosis scores (FIB-4 vs FORN 72%, FIB-4 vs BARD 36%, BARD vs FORN 46%, BARD vs BAAT 58%, FIB-4 vs BAAT 46%, BAAT vs FORN 62%). Each index was differently correlated with anthropometric, clinical and laboratory variables.

Conclusion: Indices evaluated retain low concordance, clinicians should be aware of these differences between steatosis/fibrosis scores when expressing a differential liver disease diagnosis or assessing the progression of a known liver disease.

Level of evidence: Level V, descriptive research.