Non-Invasive Tests to Stratify NAFLD Based on Liver-Related Events: A Review

FIB4 and VCTE show promise in predicting prognosis for NAFLD patients. These non-invasive tests offer an alternative to liver biopsies for risk stratification. Quick and easily prescribed, they can streamline referrals and specialized management. A sequential algorithm with FIB4 and VCTE may improve NAFLD care.
PUBLISHED IN: J Hepatol 2022

For NASH and NAFLD, non-invasive tests are often used to measure liver fibrosis. These measurements can, in turn, be used to predict prognosis, meaning that non-invasive tests may function as prognostic markers for NAFLD. In this study, FIB4 and VCTE were used to stratify patients with NAFLD into groups which demonstrated significantly different prognoses, illustrating their effectiveness. Although liver biopsy is the current gold standard, VCTE demonstrated a similar level of accuracy for predicting liver-related events. The optimal thresholds for the diagnosis of advanced fibrosis in NAFLD are still being discussed. However, the benefits that these non-invasive methods bring to the management of NASH is that they can be easily prescribed and give almost immediate results. An idea for a sequential algorithm was also suggested, where blood tests such as the FIB4 is used first to determine prognosis; if results are not favourable, VCTE can be used to then identify advanced fibrosis.

This review by Boursier J et al. aimed to evaluate the prognostic accuracy of FIB4 and VCTE for the prediction of liver-related in NASH and NAFLD.

Key learnings

The results of this study suggest that FIB4 and VCTE may allow for accurate prediction and risk stratification of liver-related events for patients with NASH and NAFLD. Their used instead of the currently preferred liver biopsy can allow for easier referrals and specialised management.

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Z. Beketova

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