Comment:
In the general population, there are high prevalence rates of NAFLD, non-alcoholic fatty liver disease. Hence, it is vital to identify the advanced stages of liver fibrosis in these individuals accurately to allow for proper treatment.
Non-invasive tests, such as FIB-4 and transient elastography, are valuable tools for identifying patients who require specialist care. However, the cut-off points for these tests have important implications for the decision-making process that follows.
For example, low cut-off points tend to improve sensitivity and negative predictive value, allowing the test to accurately rule out advanced fibrosis. On the other hand, a high cut-off point will improve the specificity, positive predictive value and therefore the ability to rule in advanced fibrosis. This study found that there is a large amount of heterogeneity in the cut-off points used by clinicians.
Currently, there remains a gap in the literature on the implications of such variation in cut-off points, with further research needed to understand the impact of this on patient outcomes. Guidelines are also needed to standardise the cut-offs for more consistent risk stratification in NAFLD patients.
This review by Lazarus JV et al. aimed to explore non-invasive test cut-off points used by clinicians for NAFLD risk stratification.
Key learnings
There is a large amount of heterogeneity between clinicians on the cut-offs used for non-invasive tests assessing NAFLD risk. Guidelines are needed to standardise these cut-offs, to improve consistency of these tests.
